JOB DESCRIPTION

Job Summary

The mission of Clinical Operations is to drive value through an integrated Clinical Center of Excellence and to deliver value through a highly efficient shared service.

To achieve this objective, this role will work closely with Molina enterprise Clinical Operations and Health Plan healthcare services leaders, and Medical Economics and Finance teams to drive, plan and manage a comprehensive program focused on identifying, defining, designing, implementing and tracking performance for clinical programs that bring organizational value.  Although primarily working with clinical teams, initiatives can overlap, and require collaboration, with Provider Network, Quality, Payment Integrity and other cross-functional areas.  This leadership role is expected to proactively lead this program and be accountable for its success, reporting directly to the Vice President of Clinical Value.

KNOWLEDGE/SKILLS/ABILITIES

Partner with program leadership and the Market Engagement team on initiatives and performance management at the Health Plan and Segment level. Collaborate and facilitate activities with other shared services departments and with Molina Health Plans. Collaborate with other clinical COE leaders (Quality, UM, CM, BH, LTSS). Lead teams in identifying, defining, sizing/validating, prioritizing, socializing, operationalizing and tracking clinical programs that result in financial value, as well as improve outcomes. Develop, maintain and enhance processes, tools and reports to support this function. Own and execute enterprise-wide communication plan to ensure consistent and regular messaging on plans and status. Collaborate with and leverage supporting areas and processes - Enterprise Clinical Vendor, Clinical Centers of Excellence, Clinical Analytics, Clinical Systems, Medical Economics, Market Engagement, etc. to ensure efficient and effective program delivery. Package material for senior leaders, up to and including for C Suite executives and the Molina CEO. Extend scope to more fully include related areas besides 'Medical/Clinical', for example Behavioral Health, Long Term Care. Assist in proposing and implementing an approach to ensure closer alignment between Clinical Operations and Provider Network processes for value programs that overlap end-to-end. May supervise one or more Program Managers.

JOB QUALIFICATIONS

Required Education

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).

Required Experience

7+ years managed healthcare experience with line management responsibility including clinical operations. Experience working within applicable state, federal, and third-party regulations.

Required License, Certification, Association

If licensed, license must be active, unrestricted and in good standing.

Preferred Education

Bachelor's Degree in Nursing or a master’s degree in Business, Social Work or other healthcare related field.

Preferred Experience

10+ years managed care experience Operational and process improvement experience Finance and/or Accounting experience, aptitude Strong management and leadership skills  Experienced and comfortable presenting succinctly to senior level executives  Ability to quickly assimilate information and make informed decisions  Logical, analytical thinker with great influencing, written and verbal communication abilities  Ability to handle multiple priorities and deal with ambiguity

Preferred License, Certification, Association

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

 

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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