HCS Program Manager (2373BR) Troy, Michigan
• Manages Healthcare programs providing ongoing evaluation and support to ensure compliance with standardized protocols and processes.
• Communicates program goals and provides support for the team to achieve goals and improve outcomes.
• Performs root-cause analysis when identifying errors, issues and trends and provides feedback to Healthcare Services Management team for developing plans to resolve these issues. Work with Corporate Director of Training and Implementation to develop standardized materials for training purposes.
• Conduct Quality Improvement Audits to assess Molina Healthcare Services staff educational needs and service quality and implement quality initiatives within the department as appropriate.
• Provides clear and timely verbal and written feedback of issues to team members and management.
• Reeducates employees when deficiencies in performance are identified.
• Conducts annual “inter-rater reliability” session and reports results.
• Develops and implements policies and procedures
• Analyzes utilization trends and prepares reports for management
• Provides input to management on annual evaluations.
• Records and trends individual and department review results on weekly, monthly, quarterly and annualized basis.
• Conducts special projects as directed.
• Conduct self in a professional manner at all times.
• Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
• Acts as an information and problem solving resource for Molina Healthcare Services team members.
• Complies with required workplace safety standards.
• Project management expertise.
• Excellent organizational skill with the ability to manage multiple priorities.
• Work independently and handle multiple projects simultaneously.
• Knowledge of applicable state, and federal regulations.
• In depth knowledge of NCQA, Interqual and Molina Guidelines and Processes.
• Knowledge of state and federal regulatory requirements.
• Ability to take initiative and see tasks to completion.
• Computer skills and experienced user of Microsoft Office software.
• Excellent verbal and written communication skills.
• Ability to abide by Molina’s policies.
• Maintain attendance to support required quality and quantity of work.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.
• High level of expertise and clinical knowledge related to area of concentration as applicable
Bachelor’s degree in Nursing, Social Services and/or other health related field required (equivalent combination of experience/education will be considered in lieu of Degree).
Five or more years of healthcare and/or Social Services experience with project management and/or quality management experience. Two or more years managed care experience preferably in Medicaid or Medicare.
None except as required by State Contract.
Registered Nurse. Master’s degree in Nursing, Public Health/Education, Social Services and/or related field.
Three or more years in a project management, auditing and/or quality management role in a Medicaid/Medicare Managed Care Environment.
Active, unrestricted State Registered Nursing (RN) or Social Services ( PhD, PsyD, LCSW, LPC, LSW, LMFT, LCPC) license in good standing. Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified Medical Audit Specialist (CMAS), 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. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.
Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.