5 Healthcare Roles jobs in Charlestown
Field Director, Medical Science Liaison (Immunology/Neurology)
40287 Louisville, Kentucky
Grifols Shared Services North America, Inc
Posted 1 day ago
Job Viewed
Job Description
Would you like to join an international team working to improve the future of healthcare? Do you want to enhance the lives of millions of people? Grifols is a global healthcare company that since 1909 has been working to improve the health and well-being of people around the world. We are leaders in plasma-derived medicines and transfusion medicine and develop, produce and market innovative medicines, solutions and services in more than 110 countries and regions.
The primary responsibility of the MSL Field Director is the management, performance, and coaching of a team of MSL direct reports in the Immunology and Neurology therapeutic area (MSL primary call points include Immunology, Neurology, Hematology/Oncology). The Field Director ensures compliant execution of field medical plans, strategy, and activities within Medical Affairs, as aligned with goals and objectives.
This position is a remote full-time role in the US with estimated 50% travel.
_Primary responsibilities include but are not limited to:_
+ Ultimate responsibility for scientific knowledge of self/team and oversight of a team of MSLs throughout the entire US.
+ Maintains clinical knowledge of designated therapeutic area(s) and broad market knowledge.
+ Provides leadership and serves as primary point of contact for operational/executional requests and solutions for the therapeutic area(s).
+ Partners with the Medical Directors, National MSL Sr Director, and North America Medical Affairs Sr Director to develop field medical strategies and tactics
+ Responsible for the MSL team's execution of field medical strategy for the assigned therapeutic area(s)
+ Conducts and/or assists MSLs in conducting formal presentations to appropriate groups such as the following: key accounts, managed care organizations, integrated systems, national medical associations, and medical schools. Acts as an "ambassador" representing Grifols' position and interests.
+ Participates and contributes in cross-functional teams (e.g., sales, marketing, global medical affairs) regarding field-based activities, medical insights, competitor activity gathering, data analysis, and evaluation of new and innovative initiatives.
+ Involved in the hiring, training, performance coaching, and overseeing the work of a team of MSL direct reports. Maintains the highest level of proficiency in the MSL function
+ Works with other MSL Field Directors regarding standardization and consistency of MSL role. Identifies opportunities for cross-functional integration of MSL roles and activities at the field level.
+ Ensures team's work performance and deliverables meet or exceed goals and objectives.
+ Ensures compliance with all applicable regulatory, legal, and operational rules and procedures of their team.
_Skills/Qualifications/Education:_ (To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, education, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions)
+ Previous leadership experience managing a team of MSLs (e.g., MSL Field Director, Regional MSL Director, National MSL Director, or equivalent) and proven history of success required.
+ Strong science/clinical background with advanced degree in a scientific field of study (PharmD, MD, PhD, or advanced/Master's nursing degree)
+ Typically requires 4 or more years of pharmaceutical industry experience as a field-based medical science liaison.
+ Experience developing and executing Key Opinion Leader territory plans, medical plans, and other field medical strategies.
+ Multi-dimensional in abilities to work on simultaneous tasks and work cross-functionally at various levels of the organization.
+ Strong organizational and collaborative skills, good personal initiative, attention to detail, and time management skills.
+ Self-directed, intrinsically motivated, flexible in changes in the organization and able to excel with minimal direction in a dynamic environment.
+ Excellent ability to understand, interpret, and communicate complex scientific and medical information and data.
+ Ability to comfortably converse with key academic opinion leaders regarding highly technical information.
+ Ability to manage a demanding travel schedule and be flexible.
+ Depending on the area of assignment, directly related experience or a combination of directly related education and experience and/or competencies may be considered in place of the stated requirements. Example: If a job level requires a bachelor's degree plus 4 years of experience, an equivalency could include 8 years of experience, an associate's degree with 6 years of experience, or a master's degree with 2 years of experience.
Must possess a valid driver's license in the state in which the employee works and meet the Qualifying Driver Criteria of the Grifols Fleet Program which includes but is not limited to a 5 year Motor Vehicle Records (MVR) lookback of major driving violations.
Pay Scale: The estimated pay scale for the Field Director, Medical Science Liaisons , Immunology/Neurology role based in the United States (non-California), is $195,000.00 - $50,000.00 per year. Additionally, the position is eligible to participate in 30% of the company bonus pool. We offer a wide variety of benefits including, but not limited to: Medical, Dental, Vision, PTO, 9 paid Holidays per year, up to 5% 401(K) match and tuition reimbursement. Final compensation packages will ultimately depend on education, experience, skillset, knowledge, where the role is performed, internal equity and market data. We are committed to offering our employees opportunities for professional growth and career progression. Grifols is a global healthcare organization with employees in 30 countries focused on patient health and providing impactful results. Since our humble beginnings in 1909, Grifols has been a family company that prides itself on its family-like culture. Our company has more than tripled over the last 10 years, and you can grow with us!
For Washington State: Currently, the first year PTO accrual for this role is 160 hours per year. Then, after completion of 365 days of employment the PTO accrual for this role will increase to 180 hours per year.
For California: The estimated pay scale for the Field Director, Medical Science Liaisons , Immunology/Neurology role based in California, is 205,000.00- 250,000.00 per year.
Work is performed in an office environment with exposure to electrical office equipment. Frequently sits for 6-8 hours per day. Frequent hand movement of both hands with the ability to make fast, simple movements of the fingers, hands, and wrists. Occasionally walks. Occasionally bends and twists neck. Light to moderate lifting and carrying objects with a maximum lift of 25lbs. Frequently drives to site locations with occasional travel within the United States. Able to communicate complex information and ideas so others will understand; with the ability to listen to and understand information and ideas presented through spoken words and sentences. Works independently with little guidance or reliance on oral or written instructions and plans work schedules to meet goals. Frequently interacts with others, relates sensitive information to diverse groups. Must work with diverse groups to obtain consensus on issues. Ability to apply abstract principles to solve complex conceptual issues. #LI-CB1
Third Party Agency and Recruiter Notice:
Agencies that present a candidate to Grifols must have an active, nonexpired, Grifols Agency Master Services Agreement with the Grifols Talent Acquisition Department. Additionally, agencies may only submit candidates to positions that they have been engaged to work on by a Grifols Recruiter. All resumes must be sent to a Grifols Recruiter under these terms or they will be considered a Grifols candidate.
**Grifols provides equal employment opportunities to applicants and employees without regard to race; color; sex; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; status as a protected veteran or spouse/family member of a protected veteran; or disability. We will consider for employment all qualified applicants in a manner consistent with the requirements of all applicable laws.**
Learn more about Grifols ( ID:**
**Type:** Regular Full-Time
**Job Category:** Medical Affairs
The primary responsibility of the MSL Field Director is the management, performance, and coaching of a team of MSL direct reports in the Immunology and Neurology therapeutic area (MSL primary call points include Immunology, Neurology, Hematology/Oncology). The Field Director ensures compliant execution of field medical plans, strategy, and activities within Medical Affairs, as aligned with goals and objectives.
This position is a remote full-time role in the US with estimated 50% travel.
_Primary responsibilities include but are not limited to:_
+ Ultimate responsibility for scientific knowledge of self/team and oversight of a team of MSLs throughout the entire US.
+ Maintains clinical knowledge of designated therapeutic area(s) and broad market knowledge.
+ Provides leadership and serves as primary point of contact for operational/executional requests and solutions for the therapeutic area(s).
+ Partners with the Medical Directors, National MSL Sr Director, and North America Medical Affairs Sr Director to develop field medical strategies and tactics
+ Responsible for the MSL team's execution of field medical strategy for the assigned therapeutic area(s)
+ Conducts and/or assists MSLs in conducting formal presentations to appropriate groups such as the following: key accounts, managed care organizations, integrated systems, national medical associations, and medical schools. Acts as an "ambassador" representing Grifols' position and interests.
+ Participates and contributes in cross-functional teams (e.g., sales, marketing, global medical affairs) regarding field-based activities, medical insights, competitor activity gathering, data analysis, and evaluation of new and innovative initiatives.
+ Involved in the hiring, training, performance coaching, and overseeing the work of a team of MSL direct reports. Maintains the highest level of proficiency in the MSL function
+ Works with other MSL Field Directors regarding standardization and consistency of MSL role. Identifies opportunities for cross-functional integration of MSL roles and activities at the field level.
+ Ensures team's work performance and deliverables meet or exceed goals and objectives.
+ Ensures compliance with all applicable regulatory, legal, and operational rules and procedures of their team.
_Skills/Qualifications/Education:_ (To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, education, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions)
+ Previous leadership experience managing a team of MSLs (e.g., MSL Field Director, Regional MSL Director, National MSL Director, or equivalent) and proven history of success required.
+ Strong science/clinical background with advanced degree in a scientific field of study (PharmD, MD, PhD, or advanced/Master's nursing degree)
+ Typically requires 4 or more years of pharmaceutical industry experience as a field-based medical science liaison.
+ Experience developing and executing Key Opinion Leader territory plans, medical plans, and other field medical strategies.
+ Multi-dimensional in abilities to work on simultaneous tasks and work cross-functionally at various levels of the organization.
+ Strong organizational and collaborative skills, good personal initiative, attention to detail, and time management skills.
+ Self-directed, intrinsically motivated, flexible in changes in the organization and able to excel with minimal direction in a dynamic environment.
+ Excellent ability to understand, interpret, and communicate complex scientific and medical information and data.
+ Ability to comfortably converse with key academic opinion leaders regarding highly technical information.
+ Ability to manage a demanding travel schedule and be flexible.
+ Depending on the area of assignment, directly related experience or a combination of directly related education and experience and/or competencies may be considered in place of the stated requirements. Example: If a job level requires a bachelor's degree plus 4 years of experience, an equivalency could include 8 years of experience, an associate's degree with 6 years of experience, or a master's degree with 2 years of experience.
Must possess a valid driver's license in the state in which the employee works and meet the Qualifying Driver Criteria of the Grifols Fleet Program which includes but is not limited to a 5 year Motor Vehicle Records (MVR) lookback of major driving violations.
Pay Scale: The estimated pay scale for the Field Director, Medical Science Liaisons , Immunology/Neurology role based in the United States (non-California), is $195,000.00 - $50,000.00 per year. Additionally, the position is eligible to participate in 30% of the company bonus pool. We offer a wide variety of benefits including, but not limited to: Medical, Dental, Vision, PTO, 9 paid Holidays per year, up to 5% 401(K) match and tuition reimbursement. Final compensation packages will ultimately depend on education, experience, skillset, knowledge, where the role is performed, internal equity and market data. We are committed to offering our employees opportunities for professional growth and career progression. Grifols is a global healthcare organization with employees in 30 countries focused on patient health and providing impactful results. Since our humble beginnings in 1909, Grifols has been a family company that prides itself on its family-like culture. Our company has more than tripled over the last 10 years, and you can grow with us!
For Washington State: Currently, the first year PTO accrual for this role is 160 hours per year. Then, after completion of 365 days of employment the PTO accrual for this role will increase to 180 hours per year.
For California: The estimated pay scale for the Field Director, Medical Science Liaisons , Immunology/Neurology role based in California, is 205,000.00- 250,000.00 per year.
Work is performed in an office environment with exposure to electrical office equipment. Frequently sits for 6-8 hours per day. Frequent hand movement of both hands with the ability to make fast, simple movements of the fingers, hands, and wrists. Occasionally walks. Occasionally bends and twists neck. Light to moderate lifting and carrying objects with a maximum lift of 25lbs. Frequently drives to site locations with occasional travel within the United States. Able to communicate complex information and ideas so others will understand; with the ability to listen to and understand information and ideas presented through spoken words and sentences. Works independently with little guidance or reliance on oral or written instructions and plans work schedules to meet goals. Frequently interacts with others, relates sensitive information to diverse groups. Must work with diverse groups to obtain consensus on issues. Ability to apply abstract principles to solve complex conceptual issues. #LI-CB1
Third Party Agency and Recruiter Notice:
Agencies that present a candidate to Grifols must have an active, nonexpired, Grifols Agency Master Services Agreement with the Grifols Talent Acquisition Department. Additionally, agencies may only submit candidates to positions that they have been engaged to work on by a Grifols Recruiter. All resumes must be sent to a Grifols Recruiter under these terms or they will be considered a Grifols candidate.
**Grifols provides equal employment opportunities to applicants and employees without regard to race; color; sex; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; status as a protected veteran or spouse/family member of a protected veteran; or disability. We will consider for employment all qualified applicants in a manner consistent with the requirements of all applicable laws.**
Learn more about Grifols ( ID:**
**Type:** Regular Full-Time
**Job Category:** Medical Affairs
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0
Healthcare Services Operations Support Auditor
40287 Louisville, Kentucky
Molina Healthcare
Posted today
Job Viewed
Job Description
JOB DESCRIPTION Job SummaryProvides support for non-clinical healthcare services auditing activities. Responsible for performing audits for non-clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
- Performs audits of non-clinical staff in utilization management, care management, member assessment, and/or other teams - monitoring for compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state and federal guidelines and requirements.
- Reports outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
- Ensures auditing approaches follow a Molina standard in approach and tool use.
- Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
- Demonstrates professionalism in all communications.
- Adheres to departmental standards, policies, protocols.
- Maintains detailed records of auditing results.
- Assists healthcare services with developing training materials or job aids as needed to address findings in audit results.
- Meets minimum production standards related to non-clinical auditing.
- May conduct staff trainings as needed.
- Communicates with quality, and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.
Required Qualifications
- At least 2 years health care experience, preferably in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
- Strong analytical and problem-solving skills.
- Ability to work in a cross-functional, professional environment.
- Ability to work on a team and independently.
- Excellent verbal and written communication skills.
- Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
- Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) non-clinical review/auditing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $24 - $56.17 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Essential Job Duties
- Performs audits of non-clinical staff in utilization management, care management, member assessment, and/or other teams - monitoring for compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state and federal guidelines and requirements.
- Reports outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
- Ensures auditing approaches follow a Molina standard in approach and tool use.
- Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
- Demonstrates professionalism in all communications.
- Adheres to departmental standards, policies, protocols.
- Maintains detailed records of auditing results.
- Assists healthcare services with developing training materials or job aids as needed to address findings in audit results.
- Meets minimum production standards related to non-clinical auditing.
- May conduct staff trainings as needed.
- Communicates with quality, and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.
Required Qualifications
- At least 2 years health care experience, preferably in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
- Strong analytical and problem-solving skills.
- Ability to work in a cross-functional, professional environment.
- Ability to work on a team and independently.
- Excellent verbal and written communication skills.
- Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
- Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) non-clinical review/auditing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $24 - $56.17 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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1
Healthcare Services Operations Support Auditor
40287 Louisville, Kentucky
Molina Healthcare
Posted 1 day ago
Job Viewed
Job Description
JOB DESCRIPTION
Job Summary
Provides support for non-clinical healthcare services auditing activities. Responsible for performing audits for non-clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
- Performs audits of non-clinical staff in utilization management, care management, member assessment, and/or other teams - monitoring for compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state and federal guidelines and requirements.
- Reports outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
- Ensures auditing approaches follow a Molina standard in approach and tool use.
- Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
- Demonstrates professionalism in all communications.
- Adheres to departmental standards, policies, protocols.
- Maintains detailed records of auditing results.
- Assists healthcare services with developing training materials or job aids as needed to address findings in audit results.
- Meets minimum production standards related to non-clinical auditing.
- May conduct staff trainings as needed.
- Communicates with quality, and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.
Required Qualifications
- At least 2 years health care experience, preferably in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
- Strong analytical and problem-solving skills.
- Ability to work in a cross-functional, professional environment.
- Ability to work on a team and independently.
- Excellent verbal and written communication skills.
- Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
- Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) non-clinical review/auditing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $24 - $56.17 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Job Summary
Provides support for non-clinical healthcare services auditing activities. Responsible for performing audits for non-clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
- Performs audits of non-clinical staff in utilization management, care management, member assessment, and/or other teams - monitoring for compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state and federal guidelines and requirements.
- Reports outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
- Ensures auditing approaches follow a Molina standard in approach and tool use.
- Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
- Demonstrates professionalism in all communications.
- Adheres to departmental standards, policies, protocols.
- Maintains detailed records of auditing results.
- Assists healthcare services with developing training materials or job aids as needed to address findings in audit results.
- Meets minimum production standards related to non-clinical auditing.
- May conduct staff trainings as needed.
- Communicates with quality, and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.
Required Qualifications
- At least 2 years health care experience, preferably in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
- Strong analytical and problem-solving skills.
- Ability to work in a cross-functional, professional environment.
- Ability to work on a team and independently.
- Excellent verbal and written communication skills.
- Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
- Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) non-clinical review/auditing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $24 - $56.17 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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2
VP, Healthcare Services (Work Location: Kentucky)
40287 Louisville, Kentucky
Molina Healthcare
Posted 1 day ago
Job Viewed
Job Description
**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: $161,914.25 - $315,733 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**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: $161,914.25 - $315,733 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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3
Medical Biller Jobs - Hiring Immediately
40201 Louisville, Kentucky
MyJobResource
Posted today
Job Viewed
Job Description
We are currently looking for individuals to fulfill Part-Time and Full-Time Medical Biller positions. No experience is required to apply for the position. Training is provided through former experienced employees and available to hired applicants. We are looking for individuals able to carry out various tasks. Individuals must be hardworking and task-oriented. Don't Wait! Fill out a Profile Now! MyJobResource is a staffing and recruitment industry job search engine. We specialize in finding the exact company to suit your needs. We help match job seekers to the right jobs in either full-time or temporary positions. Assignments are typically made depending on the ratio of candidates to jobs, skill-set, and experience. The companies we work with pay us for the services we provide to find the right people for their job openings.
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