Medical Support Services - Gainesville, 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.

Provides direction to and assists Molina State Health Plans enterprise-wide with implementing, monitoring, and achieving the Long Term Services & Supports (LTSS) program functions and goals per contract responsibilities.

• Provides leadership on the structural and clinical integration of LTSS services with Medical, Behavioral Health, and Pharmacy services.
• Refines and modifies clinical and social programs to meet regulatory requirements in multiple states while maintaining the integrity of enterprise standardization.
• Provides direction to State Plan leadership to ensure implementation of programs meet financial, utilization and quality outcomes.
• Conducts or oversees ongoing monitoring and auditing of plan performance on quality and outcome measures to determine success in LTSS standardization.
• Bachelor's Degree in Public Health, Public Policy, Health Administration, Gerontology, Social Work, or related field

5 years health care management experience, including State Medicaid LTC (both institutional and home and community based).

• Proven ability to implement an effective monitoring program to include providing constructive criticism and requiring acceptable corrective action plans.
• Management of professional and non-professional staff.
• Active and unrestricted applicable State-Licensed Nurse, Licensed Independent Social Worker (LISW), or has Master's Degree in Nursing, Healthcare, Social Work, Gerontology or other healthcare field.

Master's Degree in Nursing, Healthcare, Social Work, Gerontology or other healthcare field preferred.
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.