Mgr Case Management (4441BR) Columbus, Ohio

Job Summary
A person with strong leadership, effective communication and negotiation skills, possess comprehensive working knowledge of the healthcare industry, familiarity with regulations and contractual obligations and parameters of all types of reimbursements.  Must demonstrate skill in administrative functions of accountability, decision-making and time management.
Essential Functions
• Provide direct case management services to patients and provide training and direction to support the Case Manager’s effectively completing their assigned responsibilities; managing caseloads, interpreting regulations and  required policies, operational procedures and objectives; and reviewing operations in assigned area to ensure a high level of quality that is consistent with organizational standards. 
• Developing and maintaining quality improvement programs to optimize patient care
• Managing budget within department
• Collaborating with physicians and medical staff to ensure service expectations are met
• Perform case management analysis of data for presentation to medical staff and / or leadership
• Oversee the concurrent review functions with appropriate follow-up action plan and intervention
• Provides the department with high quality leadership
o Negotiates, counsels and influences individuals both inside and outside the organization
o Works cooperatively to achieve goals in a constructive and harmonious manner
o Ensures ongoing compliance with all relevant regulatory requirements
o Identifies and initiates problem resolution based on opportunities to improve through the LEAN methodology
o Initiates and proposes recommendations in areas of expertise as necessary
• Must be able to work in a fast paced environment to achieve project results; utilize independent decision making and critical thinking skills in a wide variety of situations. 
• Requires a high degree of accuracy in the performance of varied responsibilities. 
• Evidence of knowledge and skill necessary in Case Management with an understanding of level of care and medical necessity.

Required Education: 
• Bachelor’s Degree in health related field or equivalent combination of education and health care management experience

Required Experience:  
• Three years experience in a leadership role in Case Management or Utilization Review.

Required Licensure/Certification:
• State Registered Nursing License

Preferred Education:

Preferred Experience:

Preferred Licensure/Certification:
• Case Management Certification Preferred

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

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