CM Delegation Liaison

Molina Healthcare•Long Beach, CA

1d•Hybrid

About The Position

Provides support for clinical liaison delegation oversight activities in conjunction with enterprise partners and multidisciplinary teams, coordinating integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Requirements

At least 3 years of health care experience in a care management, utilization management, behavioral health, medical, and/or managed care setting, or equivalent combination of relevant education and experience.
Registered Nurse (RN), Licensed Social Worker (LSW), or Licensed Independent Social Worker (LISW). License must be active and unrestricted in state of practice.
Experience supporting clinical delegation oversight activities.
Ability to cross-collaborate within a highly matrixed organization.
Problem-solving and organizational skills.
Strong interpersonal skills.
Strong verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

Nice To Haves

Certified Case Manager (CCM).

Responsibilities

In collaboration with the enterprise delegation oversight team, coordinates, conducts and documents pre-delegation, ongoing and annual assessments to determine compliance with delegated functions.
In collaboration with the enterprise delegation oversight team, supports the implementation of newly identified delegates for care management.
Serves as subject matter expert for local health plan state provider agreements, National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), policies and procedures, quick reference guides (QRGs), audit tools and additional requirements during implementations; attends all implementation meetings and actively participates for seamless launch.
In collaboration with the enterprise delegation oversight team, develops, implements and tracks corrective action plans for any delegates identified as out of compliance with delegated responsibilities including timely follow-up actions related to the corrective action plan (CAP).
Performs ongoing monitoring of the delegates to ensure compliance with required reporting, and escalates identified issues to appropriate healthcare services leadership.
Maintains ongoing communication with delegates and acts as liaison between Molina and delegates by responding to questions, and providing guidance including education and re-education on delegated functions as needed.
Educates delegates on an ongoing basis related to Molina healthcare services programs and value added benefits available in the local market to assist Molina members meet their needs.
Attend joint operation committee (JOC) meetings as required.
Facilitates, coordinates, submits, reviews, edits and tracks communication request forms to Molina communications team in support of member materials related to the delegates, in order to facilitate state submissions and approvals.
Remains current and knowledgeable on regulatory changes and industry requirements.
Collaborates with leadership and enterprise delegation oversight team to design workplans, workflows, etc. as needed.
Collaborates with internal business partners related to the delegates; includes nurses, care managers, leadership and enterprise delegation oversight staff as needed/required.
Coordinates with care managers in behavioral health to provide consultation, resources and recommendations to vendors as needed.
Assists in preparation of documents for utilization management, care management, state, CMS, NCQA and other regulatory audits as needed.
Local travel may be required, depending on assigned delegates, state-specific regulations, and position location.