Director Healthcare Services (RN) Care Management San Diego, Imperial County
Company: Molina Healthcare
Location: San Diego
Posted on: September 23, 2022
For this position we are seeking a REGISTERED NURSE with 7 years
+ previous leadership experience in a managed care environment.
Must live in the state of CALIFORNIA. This position will oversee
San Diego and Imperial County service delivery areas. JOB
DESCRIPTIONJob SummaryMolina 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
- 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); long-term
supports and services; or nurse advice line.
- Develops, implements and/or monitors standardized protocols for
clinical and non-clinical team activities to facilitate integrated
proactive care review and management.
- Develops, performs, and promotes interdepartmental integration
and collaboration to enhance clinical services.
- 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
- Facilitates and participates in committees, task forces, work
groups and multidisciplinary teams as needed to promote
standardized Molina enterprise-wide approach to Care Management
- Ensures monthly auditing is occurring with appropriate
- Engaged in clinical training activities and outcomes.
- Develops and mentors HCS managers and supervisors.
- This a full-time position.JOB QUALIFICATIONSRequired
EducationBachelor'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,
AssociationLicense must be active, unrestricted and in good
standing.Preferred EducationMaster's Degree in Business,
Healthcare, Social Work, or related field.Preferred Experience
- 10+ years managed care experience.
- Operational and process improvement experience.Preferred
License, Certification, Association
- Active, unrestricted State Registered Nursing (RN) license in
- Utilization Management Certification (CPHM) Certified
Professional in Health Care Quality (CPHQ), or other healthcare or
management certificationTo 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.PJHSLI-BEMORE
Keywords: Molina Healthcare, San Diego , Director Healthcare Services (RN) Care Management San Diego, Imperial County, Executive , San Diego, California
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