Healthcare Operations - Edinburg, TX, United States - Molina Healthcare

Description

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.

Directs and oversees one of the following key Healthcare Services functions: case management/disease management/care transitions; utilization management (Position oversees PA authorizations and manages the inpatient certification review staff for initial, concurrent, or retrospective reviews); Collaborates with and keeps the AVP or VP of Healthcare Services informed of operational issues, staffing, resources, system, and program needs and presents solution action plan for issues.

Engaged in clinical training activities and outcomes.
This a full-time position.

Bachelor's Degree in Healthcare-related field (equivalent combination of education, experience and/or Nursing license will be considered in lieu of Bachelor's Degree).

7+ years managed healthcare experience with line management responsibility including clinical operations.
~ Master's Degree in Business, Healthcare, Social Work, or related field.
Operational and process improvement experience.

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
#Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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