Clinical Design Specialist ( RN- Pediatrics)

Molina Healthcare•Long Beach, CA

12h

About The Position

Provides subject matter expertise and leadership in clinical design and population health initiatives, supporting execution/operationalization and implementation, providing evaluation and support for post-implementation process, and ensuring compliance with regulatory and internal standards, practices, policies, and contractual commitments. Contributes to the overarching strategy in providing quality and cost-effective member care to single and multiple member populations with a focus on pediatric population health and wellbeing.

Requirements

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), Licensed Clinicians to include backgrounds such as MSW, LCSWs etc.
Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, 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 program proficiency, and ability to navigate online portals and databases.

Nice To Haves

Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
Experience creating executive summaries and decks as well as comfort presenting to varying stakeholders and audiences, including executive leadership
Clinical nursing experience
Leadership and change management experience.
Medicaid/Medicare/Duals population experience.
Six Sigma Green Belt or higher certification
Pediatric experience in a children's hospital or specialty medical setting
Strong command of writing and editing.

Responsibilities

Supports Population Health Transformation and integrated clinical model concept design.
Lead clinical design and population health projects: Collaboratively plan and execute initiatives that strengthen care management, transitions of care, and population health strategies across multiple markets.
Develop and standardize workflows: Design and implement clinical workflows, tools, and protocols that promote whole-person, timely, and coordinated care.
Drive process improvement and change management: Identify opportunities for efficiency and quality improvement, ensuring alignment with organizational goals and compliance requirements.
Serve as a clinical subject matter expert: Provide guidance on best practices for care management, including cross functional teams such as utilization management, and quality.
Communicate and align strategy: Partner with stakeholders to share clinical and operational needs into actionable requirements, ensuring consistent messaging and adoption.
Create supporting documentation: Develop business requirements, test plans, training materials, and other resources to support program execution and sustainability.
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.