Director, Inpatient Utilization Management (RN)

Molina Healthcare•CA, CA

9d•$101,721 - $198,356•Remote

About The Position

This position requires California RN Licensure and significant IPA delegation experience. The role leads and directs a multidisciplinary team of healthcare services professionals in functions such as utilization management, care management, behavioral health, and other programs. The Director is responsible for assessing, facilitating, planning, and coordinating the integrated delivery of care across the continuum. This role participates with senior leadership to establish strategic plans and objectives, contributing to the overarching strategy to provide quality and cost-effective member care.

Requirements

At least 8 years health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
At least 3 years health care management/leadership required.
Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). 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.
Experience working within applicable state, federal, and third party regulations.
Ability to manage conflict and lead through change.
Operational and process improvement experience.
Ability to work cross-collaboratively across a highly matrixed organization.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
California RN Licensure.
Significant IPA delegation experience.

Nice To Haves

Registered Nurse (RN). License must be active and unrestricted in state of practice.
Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
Medicaid/Medicare population experience.
Clinical experience.

Responsibilities

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).