Supv Case Management
Molina Healthcare - New Mexico

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Job Summary

Responsible for overseeing the Integrated Case Management staff focused on assisting Molina Healthcare members with their health care needs to achieve optimal clinical, financial and quality of life outcomes. Monitors information daily as appropriate including member metrics and staff productivity. Evaluates the services provided and outcomes achieved by the team and recommends enhancements and/or improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines in day-to-day activities.
Essential Functions *

Oversees, coordinates and monitors all Case Management team clinical and non clinical team activities to facilitate integrated proactive utilization management. *
Functions as hands-on supervisor for daily integrated Case Management activities including Long Term Care and Behavioral Health. *
Manages and evaluates team members in the performance of various case management activities. *
Performs and promotes interdepartmental integration and collaboration to enhance the continuity of care for Molina members. *
Works with the Manager of HCS to ensure adequate staffing and service levels, and maintains customer satisfaction by implementing and monitoring staff productivity and performance indicators. *
Maintains effective team member relations. *
Conducts regular staff meetings. *
Assists with selection, orientation and mentoring of new team members. *
Conducts performance evaluations in a timely manner. *
Provides coaching, counseling and employee development and meets individually with staff at least monthly. *
Recognizes exceptional employee performance. *
Completes quality audit reviews for all Case Management staff. *
Assists team members in improving skills, creativity and problem solving. *
Collaborates with and keeps the Manager of Healthcare Services appraised of operational issues, staffing, resources, system and program needs. *
Manages and completes assigned work plan objectives and projects in a timely manner. *
Participates in committees, task forces, work groups and multidisciplinary teams as needed. *
Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement. *
Oversees staff activities to ensure compliance with regulatory and accrediting standards. *
Conducts self in a professional manner at all times. *
Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. *
Acts as an information and problem solving resource for Case Management team members. *
Interacts with medical directors regularly, as necessary. *
Facilitates open and timely communication between team members, other Molina employees and external customers. *
Complies with required workplace safety standards.
Knowledge/Skills/Abilities *

Demonstrated ability to communicate, problem solve, and work effectively with people. *
Skilled at supervising high functioning teams. *
Able to use effective management principles. *
Excellent organizational skill with the ability to manage multiple priorities. *
Work independently and handle multiple projects simultaneously. *
Knowledge of applicable state, and federal regulations. 
Knowledge of ICD-9, CPT coding and HCPC. 
Knowledge of SSI, Coordination of benefits, and Third Party Liability programs and integration. 
Familiarity with NCQA standards, state/federal regulations and measurement techniques. *
In depth knowledge of CCA and/or other Case Management tools. *
Ability to take initiative and see tasks to completion. *
Computer skills and experience with Microsoft Office Products. *
Excellent verbal and written communication skills. *
Ability to abide by Molina's policies. *
Able to maintain regular attendance based upon agreed schedule. *
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). *
Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.

Required Education:
Registered Nurse or equivalent combination of LPN/LVN and experience in lieu of RN license. Bachelor's degree in Nursing or related field required (equivalent combination of experience/education will be considered in lieu of degree).
Required Experience:
Three or more years of clinical nursing experience and two years or more utilization management experience; and at least one year of healthcare supervisory experience.
Required Licensure/Certification:
Active, unrestricted State Registered Nursing or LPN/LVN license in good standing.

Preferred Education:
Master's degree in Nursing or related field.
Preferred Experience:
Three or more years in a supervisory role in a Managed Care Environment.

Preferred Licensure/Certification:
Utilization Management Certification (CPHM) or other healthcare or management certification, 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. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.

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

Molina Healthcare - 9 months ago - save job - block
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