Talent.com
No longer accepting applications
Program Manager, Healthcare Services - Clinical Systems

Program Manager, Healthcare Services - Clinical Systems

Molina HealthcareLincoln, NE, US
2 days ago
Job type
  • Full-time
Job description

Job Summary

Provides subject matter expertise and leadership to healthcare services function - providing support for project / program / process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

  • Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion.
  • Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes.
  • May engage and oversee the work of external vendors.
  • Focuses on process improvement, organizational change management, program management and other processes relative to business needs.
  • Serves as a subject matter expert and leads healthcare services programs to meet critical needs.
  • Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
  • Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate.
  • Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents.

Required Qualifications

  • At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas : utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience.
  • Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and / or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
  • Strong analytical and problem-solving skills.
  • Strong organizational and time-management skills.
  • Ability to work in a cross-functional, professional environment.
  • Experience working within applicable state, federal, and third-party regulations.
  • Strong verbal and written communication skills.
  • Microsoft Office suite / applicable software program proficiency, and ability to navigate online portals and databases.
  • Preferred Qualifications

  • Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
  • Leadership experience.
  • Medicaid / Medicare population experience.
  • Six sigma certification
  • Experience with Agile Methodology
  • Experience with Epic
  • To all current Molina employees : If you are interested in applying for this position, please apply through the Internal Job Board.

    Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V

    Pay Range : $77,969 - $171,058 / ANNUAL

  • Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
  • Create a job alert for this search

    Clinical Program Manager • Lincoln, NE, US

    Related jobs
    • Promoted
    Medical Director - Arizona Licensed

    Medical Director - Arizona Licensed

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a Clinical Advocacy and Support Medical Director, Internist, Surgery or Plastic Surgery Preferred - Remote. Key Responsibilities Conduct coverage reviews based on individu...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Healthcare Implementation Analyst

    Healthcare Implementation Analyst

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for an Implementation Business Analyst to create business requirements and liaise between Business Operations and Technology IT teams for new projects and improvements.Key Resp...Show moreLast updated: 22 hours ago
    • Promoted
    • New!
    Senior Manager Clinical Biomarkers

    Senior Manager Clinical Biomarkers

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a Senior Manager of Clinical Biomarkers.Key Responsibilities Lead the development and execution of clinical biomarker plans aligned with clinical development strategy Ov...Show moreLast updated: 12 hours ago
    • Promoted
    Solutions Lead - Medical Technology

    Solutions Lead - Medical Technology

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a Solutions Lead - Med Tech.Key Responsibilities Conduct data analysis and generate insights by partnering with Sales Directors to design solutions using healthcare claim...Show moreLast updated: 2 days ago
    • Promoted
    • New!
    Associate Practice Manager

    Associate Practice Manager

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for an Associate Practice Manager.Key Responsibilities Assist in overseeing administrative, care coordination, and field support teams to ensure timely and high-quality patie...Show moreLast updated: 18 hours ago
    • Promoted
    • New!
    Healthcare Industry Solutions VP

    Healthcare Industry Solutions VP

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a VP of Healthcare Industry Solutions.Key Responsibilities Develop actionable solution offerings based on industry trends for healthcare providers Engage with clients an...Show moreLast updated: 20 hours ago
    • Promoted
    Pennsylvania Licensed Care Manager Supervisor

    Pennsylvania Licensed Care Manager Supervisor

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a Professional Care Manager, Supervisor (RN).Key Responsibilities Oversee care coordination functions for clinical staff, including supervision, coaching, and counseling ...Show moreLast updated: 1 day ago
    • Promoted
    • New!
    Physician Liaison

    Physician Liaison

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a Physician Liaison.Key Responsibilities Develop and maintain relationships with targeted physicians and clinical referral sources Coordinate community engagement activi...Show moreLast updated: 22 hours ago
    • Promoted
    • New!
    State Licensed Behavioral Health Director

    State Licensed Behavioral Health Director

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a Senior Director, Utilization Management - Behavioral Health.Key Responsibilities Lead and oversee behavioral health management within the utilization management organiz...Show moreLast updated: 20 hours ago
    • Promoted
    Healthcare Industry Success Leader

    Healthcare Industry Success Leader

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for an Industry Success Leader (HCLS).Key Responsibilities Serve as a Consulting Leader, leveraging domain expertise to improve client business outcomes Own and develop a bo...Show moreLast updated: 1 day ago
    • Promoted
    • New!
    Medical Director, US Licensed

    Medical Director, US Licensed

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a Medical Director - US Medical Lead - Evenity (Bone).Key Responsibilities Support the development and execution of US product medical strategy and lifecycle management ...Show moreLast updated: 18 hours ago
    • Promoted
    Nurse Manager - Emergency (West Campus)

    Nurse Manager - Emergency (West Campus)

    Bryan HealthLINCOLN, Nebraska, US
    Full-time
    Provides leadership and supervision of daily operations for assigned services or patient care units.Assures the delivery of quality, patient-centered care in a manner reflective of the Medical Cent...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    RN Denials Management Associate Manager

    RN Denials Management Associate Manager

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for an Associate Manager RN Denials Management.Key Responsibilities Oversee operations of the team to ensure efficient payer denial and appeal reviews Supervise team members...Show moreLast updated: 16 hours ago
    • Promoted
    • New!
    Clinical Service Excellence Manager

    Clinical Service Excellence Manager

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a Clinical Service Excellence Manager to oversee clinical processes and support Neurology programs. Key Responsibilities Oversee clinical processes and serve as the client...Show moreLast updated: 14 hours ago
    • Promoted
    • New!
    Delaware Licensed Medical Director

    Delaware Licensed Medical Director

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a Medical Director for long term care.Key Responsibilities Ensure outstanding medical care and optimal health outcomes for residents Provide direct patient care while ov...Show moreLast updated: 20 hours ago
    • Promoted
    • New!
    Senior Manager, Medical Writing

    Senior Manager, Medical Writing

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a Senior Manager, Medical Writing (Remote).Key Responsibilities Lead complex writing assignments and ensure timely completion of scientifically accurate projects Manage ...Show moreLast updated: 20 hours ago
    • Promoted
    Nurse Manager

    Nurse Manager

    Bryan HealthLINCOLN, Nebraska, US
    Full-time
    Provides leadership and supervision of daily operations for assigned services or patient care units.Assures the delivery of quality, patient-centered care in a manner reflective of the Medical Cent...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    New Mexico Licensed Behavioral Medical Director

    New Mexico Licensed Behavioral Medical Director

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a Behavioral Medical Director, licensed and residency in New Mexico, to work remotely.Key Responsibilities Ensure delivery of cost-effective quality care incorporating ev...Show moreLast updated: 12 hours ago
    • Promoted
    Medical Director - Utilization Management

    Medical Director - Utilization Management

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a Medical Director Utilization Management - Clinical Advocacy and Support.Key Responsibilities : Conduct coverage reviews and render coverage determinations based on membe...Show moreLast updated: 1 day ago
    • Promoted
    Healthcare Help Desk Supervisor

    Healthcare Help Desk Supervisor

    VirtualVocationsLincoln, Nebraska, United States
    Full-time
    A company is looking for a Help Desk Supervisor - Remote US.Key Responsibilities Supervise daily operations of the Help Desk team to meet service levels and quality standards Provide coaching an...Show moreLast updated: 30+ days ago