4 Healthcare Roles jobs in Davenport

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 Manager, Healthcare Services provides operational management and oversight of integrated Healthcare Services (HCS) teams responsible for providing Molina Healthcare members with the right care at the right place at the right time and assisting them to achieve optimal clinical, financial, and quality of life outcomes.

• Responsible for clinical teams (including operational teams, where integrated) performing 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 HCS management, ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina Clinical Model.

• 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 including Behavioral Health and Long-Term Services & Supports for Molina members. Oversees Interdisciplinary Care Team meetings.

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

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

• Collates and reports on Care Access and Monitoring statistics including plan utilization, staff productivity, cost effective utilization of services, management of targeted member population, and triage activities.

• 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, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement.

JOB QUALIFICATIONS

Required Education

• Registered Nurse or equivalent combination of Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license.

• OR Bachelor's or master's degree in Nursing, Gerontology, Public Health, Social Work, or related field.

Required Experience

• 5+ years of managed healthcare experience, including 3 or more years in one or more of the following areas: utilization management, case management, care transition and/or disease management.

• Minimum 2 years of healthcare or health plan supervisory or managerial experience, including oversight of clinical staff.

• Experience working within applicable state, federal, and third-party regulations.

Required License, Certification, Association

• If licensed, license must be active, unrestricted and in good standing.

• Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

Master's Degree preferred.

Preferred Experience

• 3+ years supervisory/management experience in a managed healthcare environment.

• Medicaid/Medicare Population experience with increasing responsibility.

• 3+ years of clinical nursing experience.

Preferred License, Certification, Association

Any of the following:

Certified Case Manager (CCM), Certified Professional in Healthcare 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: $77,969 - $171,058 / ANNUAL

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

**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 Manager, Healthcare Services provides operational management and oversight of integrated Healthcare Services (HCS) teams responsible for providing Molina Healthcare members with the right care at the right place at the right time and assisting them to achieve optimal clinical, financial, and quality of life outcomes.
+ Responsible for clinical teams (including operational teams, where integrated) performing 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 HCS management, ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina Clinical Model.
+ 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 including Behavioral Health and Long-Term Services & Supports for Molina members. Oversees Interdisciplinary Care Team meetings.
+ Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities.
+ Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
+ Collates and reports on Care Access and Monitoring statistics including plan utilization, staff productivity, cost effective utilization of services, management of targeted member population, and triage activities.
+ 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, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement.
**JOB QUALIFICATIONS**
**Required Education**
+ Registered Nurse or equivalent combination of Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license.
+ OR Bachelor's or master's degree in Nursing, Gerontology, Public Health, Social Work, or related field.
**Required Experience**
+ 5+ years of managed healthcare experience, including 3 or more years in one or more of the following areas: utilization management, case management, care transition and/or disease management.
+ Minimum 2 years of healthcare or health plan supervisory or managerial experience, including oversight of clinical staff.
+ Experience working within applicable state, federal, and third-party regulations.
**Required License, Certification, Association**
+ If licensed, license must be active, unrestricted and in good standing.
+ Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
**Preferred Education**
Master's Degree preferred.
**Preferred Experience**
+ 3+ years supervisory/management experience in a managed healthcare environment.
+ Medicaid/Medicare Population experience with increasing responsibility.
+ 3+ years of clinical nursing experience.
**Preferred License, Certification, Association**
Any of the following:
Certified Case Manager (CCM), Certified Professional in Healthcare 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: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job Summary
Provides lead level clinical support to healthcare services team supporting one or more of the following functions: care management, utilization management, care transitions, long-term services and supports (LTSS), behavioral health, and other clinical programs, and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
- Provides level support to healthcare services department staff - devising/implementing delegation assignment strategies, facilitating healthcare services processes and communicating/coordinating activities.
- Resolves issues and complaints that arise in day-to-day healthcare services operations and communicates escalation issues to healthcare services leadership.
- Assists in training of healthcare services staff according to department standards, policies and procedures.
- Maintains a minimal caseload to ensure adherence to appropriate guidelines and provide assistance to staff who have an ongoing member caseloads that may required additional support.
- Collaborates with and keeps healthcare service leadership apprised of operational issues, staffing issues, system and program needs.
- As a subject matter expert clinical lead, provides support, recommendations and education as appropriate to all other clinical and non-clinical staff.
- Monitors healthcare services staff workload for adherence to policies, procedures, guidelines, and program specific requirements.
- Actively participates in the department auditing program to review, communicate findings and identify opportunities for improved quality and compliance.
- Shares quality and productivity scores with individual staff for awareness.
- Provides feedback to healthcare services leadership on staff performance issues and consults with leadership on corrective action as necessary for performance improvement.
- May collaborate with leadership to ensure the daily authorization reconciliation report (DARR) is run each work day and cases found non-compliant or missing compliance elements are remediated promptly.
- May collaborate with leadership ensuring the care management monitoring tool (CMMT) is run every work day and cases are addressed to maintain health rid assessment (HRA) and care plan compliance.
- Acts as liaison to both internal and external customers on behalf of both Molina and healthcare services department areas.
- Maintains confidentiality, effective workplace relationships and adheres to company code of conduct.
- Attends/participates in departmental, company-wide, and external committees, task forces, or work groups as assigned. groups as assigned.
- Local travel may be required (based upon state/contractual requirements).
Required Qualifications
- At least 4 years experience in health care, and at least 2 years of managed care experienced in utilization management
- Registered Nurse (RN) ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
- Demonstrated knowledge of community resources.
- Proactive and detail-oriented.
- Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
- Ability to work independently, with minimal supervision and demonstrate self-motivation.
- Responsive in all forms of communication.
- Ability to remain calm in high-pressure situations.
- Ability to develop and maintain professional relationships.
- Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
- Excellent problem-solving, and critical-thinking skills.
- Strong verbal and written communication skills.
- Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
- Registered Nurse (RN). License must be active and unrestricted in state of practice.
- Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
- Medicaid/Medicare population experience.
- Clinical experience.
Prior experience overseeing Utilization Management processes, interQual, MCG guidelines, PEGA experience etc.
Work schedule: full time daytime business hours, with some weekends and holiday support may be required.
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: $29.05 - $56.64 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.