Program Director, Clinical Systems

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

• Works within the clinical systems matrix to develop strategies and manage initiatives with oversight from an VP as needed.
• Serves as industry Subject Matter Expert in the functional area and leads programs to meet critical needs.
• Escalates gaps and barriers in implementation and compliance to VP and senior management.
• Consultative role, develops business case methodologies for programs, develops and coordinates implementation of business strategy.
• Collaborates and facilitates activities with other units at corporate and Molina Plans.

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

• 5+ years experience driving clinical systems strategies, including digital and artificial intelligence automation for Utilization and Case Management.  
• Experience managing multiple initiatives within a complex, highly matrixed organization
• 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

• Registered Nurse, Informatics
• 10+ years managed care experience
• Operational and process improvement experience

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.