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
The VP, Healthcare Services is responsible for oversight and management of the state health plan's Healthcare Services (clinical operations) teams including Utilization Management (prior-authorization, inpatient review) and Care Management (case/health management and transition of care). This position works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets.
Works with the Healthcare Services management team to achieve successful implementation of Molina clinical strategy and direction.
Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operations functions and promote quality cost effective health care for Molina members.
Mentors, guides, and develops skills of management team members in a consistent and effective manner.
Develops initiatives to achieve budgeted reductions in medical expenses and increases in quality scores.
Develops Healthcare Services department budget and ensures budget targets are met.
Manages implementation of analytical studies that quantify the benefits of Healthcare Services programs to ensure that resources are appropriately allocated, operational controls exist, and efficiencies are maximized.
Facilitates integration of care coordination, long term care, behavioral health, and chemical dependency programs.
Continually refines operational processes and champions review of team processes, workflows, and activities.
Articulates project requirements and anticipated outcomes to the Molina Project Management Office for identified projects/strategies to improve the efficiency of clinical operations teams to meet cost and quality goals.
Accountable for ensuring compliance with contractual, accreditation and regulatory requirements for all Healthcare Services teams.
Participates personally or assigns appropriate staff to Molina Quality Committees and external Community Committees to represent the Healthcare Services department.
Ensures effective inter-departmental collaboration and interaction between Healthcare Services staff and other departments.
Ensures monthly auditing of HCS staff is performed and appropriate actions and/or coaching occur.
Responsible for oversight of clinical training activities and outcomes.
Responsible for HCS-related delegation oversight monitoring.
JOB QUALIFICATIONS
Required Education
Master's Degree or equivalent combination of education and work experience.
Required Experience
10 years managed care experience with line management responsibility including clinical operations.
Experience working within applicable state, federal, and third-party regulations.
Operational and process improvement experience.
Strong communication and teaming/interpersonal skills.
Strong leadership capabilities and ability to initiate and maintain cross-team relationships.
Demonstrated experience meeting Quality Accreditation Standards (NCQA/HEDIS/STARS).
Required License, Certification, Association
If licensed, license must be active, unrestricted and in good standing.
Preferred Education
Master's Degree in Business or Healthcare management (i.e. MBA, MHA, MPH).
Preferred Experience
Familiarity and experience in the local market desirable.
Preferred License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification
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: $140,795 - $274,550.26 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
