Program Manager, LTSS Healthcare Services

Molina Healthcare•United States,

1d•$65,792 - $142,549•Remote

About The Position

Molina Healthcare is hiring a remote Program Manager, LTSS Healthcare Services. The position provides subject matter expertise and leadership to the healthcare services function, supporting the design, execution, evaluation, and support of projects, programs, and processes. The role ensures compliance with regulatory and internal standards, practices, policies, and contractual commitments, and contributes to strategy for delivering quality, cost-effective member care. Candidates should have experience with LTSS. Additional responsibilities may include implementing new markets, working with health plans to ensure execution, project management, and ensuring audit performance and compliance.

Requirements

At least 5 years of healthcare experience, including clinical operations experience.
At least 3 years in utilization management, care management, care transitions, behavioral health, or an equivalent combination of relevant education and experience.
One of the following credentials: RN, LVN, LPN, APSW, CHES, LPC, LPCC, or LMFT. Clinical licensure and/or certification is required only when required by state contract, regulation, business operating model, or state board licensing mandates; any required license must be active and unrestricted in the 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.
Proficiency with Microsoft Office or applicable software programs, 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 another healthcare or management certification.
Leadership experience.
Medicaid/Medicare population experience.

Responsibilities

Collaboratively plan and execute internal healthcare services projects and programs involving department or cross-functional subject matter experts, delivering products from design through completion.
Communicate ongoing program goals, evaluation, and support to help ensure compliance with standardized protocols and processes.
Engage and oversee external vendors, as needed.
Focus on process improvement, organizational change management, program management, and other processes based on business needs.
Serve as a subject matter expert and lead healthcare services programs to meet critical needs.
Communicate and collaborate with customers to analyze needs and goals and translate them into functional requirements.
Conduct quality audits to assess healthcare services staff educational needs and service quality, and implement departmental quality initiatives as appropriate.
Create business requirements documents (BRDs), test plans, requirements traceability matrices (RTMs), user training materials, and related business documents.
Potentially support implementations in new markets, work with health plans to ensure full execution, manage projects, and ensure audit performance and compliance.