Director, Care Management (4497BR) Columbus, Ohio
Job SummaryDevelopS, directsS and oversees program, policy and implementation of Care Management programs and policies focused on assisting Molina Healthcare members with their overall health care needs including Behavioral Health and Long Term Care services to achieve optimal clinical, financial and quality of life outcomes. Collaborates with the AVP Care Management to provide effective, integrated, comprehensive,standardized multidisciplinary case management enterprise wide. Evaluates the services provided and outcomes achieved by the team and recommends and develops enhancements and/or improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all accrediting requirements along with state and federal regulations and guidelines for an enterprise wide Molina standardized approach. Essential Functions• Develops, directs and oversees standardized program, policy development and implementation with regards to the Molina integrated care management model with all of the Molina Health plans
• Develops, directs and monitors enterprise wide standardized approach for all Care Management team clinical and non-clinical team activities to facilitate integrated proactive case management.
• Develops, performs and promotes interdepartmental integration and collaboration to enhance case management services including, Behavioral Health and Long Term Care services and coordination for Molina members with Molina Health Plan HCS staff..
• Collaborates with and keeps the AVP Care Management appraised of operational issues, staffing, resources, system and program needs and presents solution action plan for issues.
• Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote standardized Molina enterprise wide approach to Care Management programs.
• Develops, directs and oversees standardized Care Management programs and policies meeting accrediting requirements along with all State and Federal regulatory requirements and guidelines.
• Implements effective management skills including selection, orientation, mentoring, coaching, evaluation, recognition, creative problem solving, staff metrics and promotion of professional manner.
• Maintains professional relationships and promotes communication with Molina Health Plan HCS staff, Molina Medical Directors, other Molina department staff, Molina project management staff and business analysts, provider community,internal and external customers while identifying opportunities for improvement.
• Works with the AVP Care Management to ensure adequate staffing and service levels, and maintains customer satisfaction by implementing and monitoring staff productivity and key program performance indicators and escalates issues as needed along with suggested action plan for issue resolution.
• Manages and completes assigned work plan objectives and projects in a timely manner. Knowledge/Skills/Abilities
• Skilled at supervising high functioning teams.
• Able to use effective management principles.
• Excellent organizational skill with the ability to manage multiple priorities.
• Work independently and handle multiple projects simultaneously.
• Knowledge of applicable state, and federal regulations.
Knowledge of ICD-9, CPT coding and HCPC.
Knowledge of SSI, Coordination of benefits, and Third Party Liability programs and integration.
Familiarity with NCQA standards, state/federal regulations and measurement techniques.
• In depth knowledge of CCA and/or other Case Management tools.
• Ability to take initiative and see tasks to completion.
• Computer skills and experience with Microsoft Office Products.
• Excellent verbal and written communication skills.
• Ability to abide by Molina’s policies including workplace safety standards and company Code of Conduct.
• Able to maintain regular attendance based upon agreed schedule.
• 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.
Bachelor’s Degree in Social Worker, Registered Nurse or other Health related Degree (equivalent combination of experience/education will be considered in lieu of degree).
Five plus years of case management experience and three plus years of health plan case management experience; and at least two years of healthcare supervisory experience.
Master’s degree in health related field.
Three or more years in a supervisory role in a Managed Care Environment.
Licensed Clinical Social Worker (LCSW), Registered Nurse Board Certified in Gerontology, Certified Case Manager (CCM), 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. 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.