Director, HCS (CM) Remote in MS

$79,608 - $172,484/Yr

Molina Healthcare - Gulfport, MS

Full-time - Senior

Remote - Gulfport, MS

Insurance Carriers and Related Activities

About the position

The Director of Healthcare Services (HCS) at Molina Healthcare is responsible for overseeing key functions such as case management, utilization management, and care transitions. This role involves directing clinical operations, developing standardized protocols, and ensuring integrated care delivery for members with high needs. The director collaborates with various stakeholders to enhance clinical services and is engaged in training and mentoring staff to achieve desired patient outcomes.

Responsibilities

• Direct and oversee key Healthcare Services functions including case management, utilization management, and nurse advice line.
• Develop, implement, and monitor standardized protocols for clinical and non-clinical team activities.
• Promote interdepartmental integration and collaboration to enhance clinical services.
• Keep the AVP or VP of Healthcare Services informed of operational issues and present solution action plans.
• Facilitate and participate in committees and multidisciplinary teams to promote standardized care management programs.
• Ensure monthly auditing occurs with appropriate follow-up actions.
• Engage in clinical training activities and outcomes.
• Develop and mentor HCS managers and supervisors.

Requirements

• Bachelor's Degree in a healthcare-related field or equivalent combination of education and experience.
• 7+ years of managed healthcare experience with line management responsibility in clinical operations.
• Experience working within applicable state, federal, and third-party regulations.
• Active, unrestricted license if applicable.

Nice-to-haves

• Master's Degree in Business, Healthcare, Social Work, or related field.
• 10+ years of managed care experience.
• Operational and process improvement experience.
• Active, unrestricted State Registered Nursing (RN) license in good standing.
• Utilization Management Certification (CPHM) or Certified Professional in Health Care Quality (CPHQ).

Benefits

• Competitive benefits and compensation package.