Critical Incident Reviewer, Medicaid

**New Mexico residency required

 

Job Description

Job Summary

Molina's Medicaid Critical Incident Team oversees the Molina Healthcare of Ohio Medicaid Critical Incident Management Process in accordance with Ohio Department of Medicaid directives and Ohio Administrative Code Rule 5160-44-05. Work with members and multidisciplinary team staff to review, assist, and coordinate with Care Management to facilitate, plan, and ensure an integrated delivery of care across the continuum. Work to ensure that members progress toward desired outcomes with quality care that is member-focused and appropriate.

 

Job Duties

• Consistently monitors email inboxes for Medicaid Critical Incident referrals
• Submission and review of Medicaid Critical Incidents via the dedicated electronic documentation system
• Work with members and multidisciplinary team staff to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum
• Monitors and ensures that key activities within Incident Management Process are completed on time and accurately
• Presents data to departmental management, ODM, and other stakeholders as needed/appropriate
• Focuses on learning and systematic improvement
• Other tasks, duties, projects, and programs as assigned

 

Job Qualifications

Required Education:

• Bachelor’s Degree with RN and/or LSW licensure

Required Experience:

• Minimum 3 years’ experience in healthcare with 1 year experience in health plan quality improvement, managed care, or equivalent experience

Required Licensure or Certification:

• RN and/or LSW

Required Knowledge, Skills, and Abilities:

• Demonstrated solid business/clinical writing/documentation experience
• Ability to communicate orally and in writing
• Strong organizational skills
• Ability to adhere to strict time constraints

Preferred Qualifications

• Experience in Clinical Quality, Public Health, Healthcare, Ohio Waiver Services (Medicare/Medicaid). 5+ years of experience in Medicare and in Medicaid

 

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

 

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.