RN Director of Medical Management

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Location: EITHER DALLAS/IRVING, HOUSTON, SAN ANTONIO

Salary: 130k + based on experience

Knowledge/Skills/Abilities

• Oversees, coordinates and monitors all team activities to facilitate integrated proactive care management including Utilization Management, Case Management, Care Transitions, Behavioral Health and Long Term Care.

• Manages and evaluates team members in the performance of various health management activities.

• Participates in the development and implementation of programs to meet the needs of Molina membership.

• Performs and promotes interdepartmental integration and collaboration to enhance the continuity of care for members.

• Evaluates program performance and participates in the development of enhancement strategies as needed.

• Ensures adequate staffing and service levels, and maintains customer satisfaction by impleme0nting and monitoring staff productivity and performance indicators.

• Maintains effective team member relations.

• Conducts regular staff meetings (at least monthly).

• 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.

• Assists team members in improving skills, creativity and problem solving.

• Collaborates with and keeps the VP of Healthcare Services appraised of operational issues, staffing, resources, system and program needs.

• Assists and mentors manager responsible for supervision and coordination of daily integrated healthcare service activities.

• Manages and completes assigned work plan objectives and projects on a timely basis.

• Participates in committees, task forces, work groups and multidisciplinary teams related as needed.

• Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement. 

• Participates in the development of policies and oversees staff activities to ensure compliance with regulatory and accrediting standards.

• Creates and ensures timely and accurate reporting to executive management and appropriate committees.

• Accountable for timely reports submission to regulatory agencies and Plan Partner(s) as required contractually.

• Acts as a liaison to both internal and external customers on behalf of both Molina and the Healthcare Services Team. 

• 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 team members, physicians, hospitals, and other Molina staff.

• 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.

Oversight and management of the day to day integrated team of health plan based staff responsible for cost effective delivery of healthcare services for Molina members. Works with the Vice President of Healthcare Services and the Healthcare Services team to develop and implement effective and efficient standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operations functions and promote quality cost effective health care for Molina members. Evaluates the services provided and outcomes achieved by the team and recommends improvements for programs and staff development to ensure consistent compliance with all state and federal regulations and guidelines.• Demonstrated ability to communicate, problem solve, and work effectively with people.

• Skilled at managing high functioning interdisciplinary teams of professionals.

• Able to use effective management principles.

• Excellent organizational skills 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, COB, and TPL programs and integration.

• Familiarity with NCQA standards, regulations and measurement techniques.

• Ability to take initiative and see tasks to completion.

• Computer Literate (Microsoft Office Products).

• Excellent verbal and written communication skills.

• Ability to abide by Molina's policies.

• Ability to maintain attendance to support required quality and quantity of work.

• 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.

About the Job:

-Job does not requiring traveling

-Will report to the Associate VP

Qualifications:

-Must be an RN

-Must have bachelors in Nursing or related field

- Managed Care experience (can’t come from clinical) 

-Will be flexible on numbers of years of experience, let’s focus on 3+ Directors with Managed Care and 6+ for Managers with Managed Care

-Ability to be able to build relationships and a team. 

-Experience with line management responsibility including clinical operations, 

applicable state, federal, and third party regulations and Quality Accreditation Standards (NCQA/HEDIS). 

Preferred but not a must 

-Master's degree in business or healthcare management (i.e. MBA, MHA, MPH, MSN)    

-Familiarity and experience in the local market desirable.

-Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) Certified

-Professional in Health Care Quality (CPHQ), or other healthcare or management certification.     

Interested in being considered? 

If you are interested in applying to this position, please contact Gemma Halton 407-478-0332 ext. 153 and click the Green I’m Interested Button to email your resume.