VP, Healthcare Services (Florida)

Molina Healthcare•Long Beach, FL

10d

About The Position

Description JOB DESCRIPTION Job Summary Provides executive level strategy and leadership to a multidisciplinary team of healthcare services professionals, in some or all of the following functions: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), and other clinical programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Partners with executive leadership team to provide cohesive direction towards company goals. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties Supports executive strategy development, vision and direction for healthcare services teams including care management, care coordination, transitions of care, utilization management (prior-authorization, inpatient review), behavioral health, long-term services and supports (LTSS), and other member care focused programs. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. Collaborates with the chief medical officer and medical director team to develop and implement processes to effectively manage clinical policies to meet health care cost and quality targets. Collaborates with healthcare services and clinical operations teams at the corporate and/or health plan level to achieve successful implementation of Molina clinical strategy and direction. Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operations functions and promote quality cost-effective health care for Molina members. Mentors, guides and develops skills of healthcare services leaders and team members in a consistent and effective manner. Develops initiatives to achieve budgeted reductions in medical expenses and increases in quality scores. Develops health care services department budget and ensures budget targets are met. Manages implementation of analytical studies that quantify the benefits of healthcare services programs to ensure that resources are appropriately allocated, operational controls exist, and efficiencies are maximized. Facilitates integration of care coordination, care transitions, long-term care, behavioral health, chemical dependency and other special programs. Continually refines operational processes and champions review of team processes, workflows and activities. Articulates project requirements and anticipated outcomes to the Molina project management office for identified projects/strategies to improve the efficiency of clinical operations teams to meet cost and quality goals. Accountable for ensuring compliance with contractual, accreditation and regulatory requirements for all healthcare services teams. Participates personally or assigns appropriate staff to Molina quality committees and external community committees to represent the healthcare services department. Ensures effective interdepartmental collaboration and interaction between healthcare services staff and other departments. Ensures monthly auditing of healthcare services staff is performed and appropriate actions and/or coaching occur. Demonstrates oversight of clinical training activities and outcomes. Demonstrates accountability for healthcare services related delegation oversight monitoring.

Requirements

At least 12 years experience in health care, and at least 10 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), and progressive experience in clinical operations, or equivalent combination of relevant education and experience.
At least 7 years health care management/leadership experience.
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.
Operational and process improvement experience.
Strong interpersonal skills.
Strong leadership capabilities, and ability to initiate and maintain cross-team relationships and manage change.
Demonstrated experience meeting quality accreditation standards (National Committee for Quality Assurance (NCQA)/Healthcare Effectiveness Data Information Set (HEDIS)/Medicare STARS).
Excellent organizational and time-management skills.
Flexibility in the work environment and willingness and ability to adapt to changing organizational needs.
Excellent verbal and written communication skills.
Microsoft Office suite (including Excel), and applicable software program(s) proficiency.

Nice To Haves

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

Responsibilities

Supports executive strategy development, vision and direction for healthcare services teams including care management, care coordination, transitions of care, utilization management (prior-authorization, inpatient review), behavioral health, long-term services and supports (LTSS), and other member care focused programs.
Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
Collaborates with the chief medical officer and medical director team to develop and implement processes to effectively manage clinical policies to meet health care cost and quality targets.
Collaborates with healthcare services and clinical operations teams at the corporate and/or health plan level to achieve successful implementation of Molina clinical strategy and direction.
Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operations functions and promote quality cost-effective health care for Molina members.
Mentors, guides and develops skills of healthcare services leaders and team members in a consistent and effective manner.
Develops initiatives to achieve budgeted reductions in medical expenses and increases in quality scores.
Develops health care services department budget and ensures budget targets are met.
Manages implementation of analytical studies that quantify the benefits of healthcare services programs to ensure that resources are appropriately allocated, operational controls exist, and efficiencies are maximized.
Facilitates integration of care coordination, care transitions, long-term care, behavioral health, chemical dependency and other special programs.
Continually refines operational processes and champions review of team processes, workflows and activities.
Articulates project requirements and anticipated outcomes to the Molina project management office for identified projects/strategies to improve the efficiency of clinical operations teams to meet cost and quality goals.
Accountable for ensuring compliance with contractual, accreditation and regulatory requirements for all healthcare services teams.
Participates personally or assigns appropriate staff to Molina quality committees and external community committees to represent the healthcare services department.
Ensures effective interdepartmental collaboration and interaction between healthcare services staff and other departments.
Ensures monthly auditing of healthcare services staff is performed and appropriate actions and/or coaching occur.
Demonstrates oversight of clinical training activities and outcomes.
Demonstrates accountability for healthcare services related delegation oversight monitoring.