Shire Jobs

Job Description

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Knowledge/Skills/Abilities

• Provides management and oversight for operational teams that support one or more of the following activities: care review/utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), case management, transition of care, health management and/or member assessment.

• Typically through one or more direct report supervisors, facilitates integrated, proactive management, ensuring compliance with state and federal regulatory and accrediting standards.

• Manages and evaluates team member performance; provides coaching, counseling, employee development, and recognition; ensures ongoing, appropriate staff training; and has responsibility for the selection, orientation and mentoring of new staff.

• Performs and promotes interdepartmental/ multidisciplinary integration and collaboration to enhance the continuity of care and quality of Molina services provided.

• Functions as hands-on manager responsible for supervision and coordination of daily activities.

• Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.

• Ensures completion of staff quality audit reviews. Evaluates services provided and outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines.

• Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement..

Job Qualifications

Required Education

Associate's Degree (equivalent combination of education and relevant experience may be considered in lieu of Degree)

Required Experience

• Min. 5 years operations or administrative experience in healthcare/ health plan industry, including 1+ years as a supervisor.

• Strong communication skills

• Strong analytic and problem solving abilities

Required License, Certification, Association

n/a

Preferred Education

Associate's or Bachelor's Degree

Preferred Experience

3+ years of healthcare or health plan supervisory experience.

Managed Care operations experience.

Prior Medical Assistant experience.

Preferred License, Certification, Association

n/a

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $67,725 - $141,371 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.