Pod Lead, HCS (Clinical) (Prefer Reside in FL or SC)

Job Description

Job Summary

Molina Healthcare Services (HCS) Department 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 members 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. The Pod Lead, HCS (Clinical) functions as clinical staff lead in the health plan HCS Department.  Responsibilities include oversight capabilities of daily administrative functions including staffing schedules, productivity, and work quality.

 

Job Duties

• Maintains the philosophy of the Pod concept, through intentional engagement of both internal and external Care Pod Partners with clinical, geographical, and technological expertise who collectively develop strategies tailored to individual members and their needs.
• Devises/implements a strategy for distribution of work to the care pod team based on identified member needs, risk indicators & member preference.
• Monitors the Care Pod workload and resource capacity, ensuring ability to maintain high quality member engagement and flexibility to support the unique needs of each member managed by the Pod.
• Hosts routine (daily/ad-hoc) check-in with members of the Care Pod to strategize and prioritize around workload, capacity, interventions, and activities.
• Accountable for coordinating care pod team interventions and activities, as well as maintaining the integrity of all internal and external communications related to member needs.
• Monitors operational dashboards and leading indicators; assessing Care Pod intervention & activity effectiveness and timeliness and adjusting CM strategies as needed.
• Promotes multidisciplinary collaboration, provider outreach, and engagement of family and caregivers to enhance the continuity of care for Pod-managed members.  Leads Interdisciplinary Care Team meetings
• Keeps Clinical Leadership apprised of operational issues, staffing issues, system, and program needs.  Provides inputs and ideas to leadership about how to improve workflows, processes, and procedures to optimize the pod performance
• Evaluates the performance of the Pod, and Pod team members.  Consults with Clinical Management to devise and implement corrective action as necessary to improve Pod and Pod team member performance.
• Maintains a minimum caseload as determined by leadership, for regular outreach and management
• Provides support, recommendations, and education as appropriate to Pod Team members.
• Actively participates in the Department auditing program to review and communicate findings with staff and identify opportunities for improved quality and compliance. 
• Maintains confidentiality, cooperative and effective workplace relationships and adheres to company Code of Conduct.
• Attends/participates in departmental, company-wide, and external committees, task forces, or work groups, as assigned.  
• As an opportunity to encourage staff, share monthly quality and productivity scores with individual staff for awareness.       

 

Job Qualifications

REQUIRED EDUCATION:

Graduate from an Accredited School of Nursing.  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 a health or social science, psychology, gerontology, public health, or social work

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 3+ years in case management, disease management, managed care or medical or behavioral health settings.
• Knowledge and experience with working with persons with complex medical, b