**_For this position we are hiring for our CALIFORNIA health plan. California residents are preferred._** **_Good Project Management skills, excellent verbal and written communication skills as well as on-camera business presentation skills will be essential to be successful for this role. Training skills helpful. Knowledge of Utilization Management processes, EMR systems and Health Information Exchange very helpful. Managed care working knowledge is preferred._** **_Travel may be required 1x per year, within the state of California. Candidates who do not live in California must be willing to work Pacific business hours._** **JOB DESCRIPTION** **Job Summary** 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. **KNOWLEDGE/SKILLS/ABILITIES** + In collaboration with others, plans and executes internal Healthcare Services projects and programs involving department or cross-functional teams of subject matter experts, delivering products from the design process to completion. + Manages programs providing ongoing communication of goals, evaluation, and support to ensure compliance with standardized protocols and processes. + May engage and oversee the work of external vendors. + Focuses on process improvement, organizational change management, program management and other processes relative to the business. + Serves as a subject matter expert and leads programs to meet critical needs. + Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. + Works with operational leaders within the business to provide recommendations for process improvement opportunities. + Conducts quality audits to assess Molina Healthcare Services staff educational needs and service quality and implement quality initiatives within the department as appropriate. + Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license. + OR Bachelor's or master’s degree in Nursing, Gerontology, Public Health, Social Work or related field. **Required Experience** + 5+ years of managed healthcare experience, including 3 or more years in one or more of the following areas: utilization management, case management, care transition and/or disease management. + Minimum 2 years of healthcare or health plan supervisory or managerial experience, including oversight of clinical staff. + 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. + Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation. **Preferred Education** Master's Degree preferred. **Preferred Experience** + 3+ years supervisory/management experience in a managed healthcare environment. + Medicaid/Medicare Population experience with increasing responsibility. + 3+ years of clinical nursing experience. **Preferred License, Certification, Association** Any of the following: Certified Case Manager (CCM), Certified Professional in Healthcare 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. Pay Range: $84,067 - $163,931 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.