Director of Managed Care (RN/LPN)

California - Ability to work remote, but selected candidate must reside in the state of California.

This position requires California RN Licensure. Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Directs and oversees one or more of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral health, nurse advice line, and/or other special programs.

• Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management.
• Collaborates with and keeps healthcare services senior leadership informed of operational issues, staffing, resources, system and program needs and presents solutions/action plans for issues.
• Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs.
• Engages in clinical training activities and outcomes.
• Develops and mentors direct reporting healthcare services leadership.
• Local travel may be required (based upon state/contractual requirements).

At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.

• At least 3 years health care management/leadership required.
• Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. Ability to manage conflict and lead through change.
• Operational and process improvement experience.
• Ability to prioritize and manage multiple deadlines.
• Microsoft Office suite/applicable software program(s) proficiency.

Registered Nurse (RN). Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.

• Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $101,721 - $198,356 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.