Director, Healthcare Services; Utilization Management (Remote - GA)

This position will offer remote work flexibility, however, the selected candidate must reside in the state of Georgia.

This position will require RN Licensure.

JOB DESCRIPTION Job Summary

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. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• 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.
• Develops and promotes interdepartmental integration and collaboration to enhance clinical services.
• 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.
• Ensures monthly auditing is occurring with appropriate follow-up.
• 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).

Required Qualifications

Preferred Qualifications

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

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Pay Range : $88,453 - $172,484 / ANNUAL