Description: Our Client, A managed care company is looking to hire a Manager, Healthcare Services in Bothell, WA. Full-time benefits, relocation assistance available.

Responsibilities:

• Responsible for clinical teams (including operational teams, where integrated) performing one or more of the following activities: care review/utilization management (prior authorizations, inpatient / outpatient medical necessity, etc.), case management, transition of care, health management and/or member assessment;
• Facilitate integrated, proactive HCS management, ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina Clinical Model;
• Manage and evaluate team member performance; provide coaching, counseling, employee development, and recognition; ensures ongoing, appropriate staff training; and has responsibility for the selection, orientation and mentoring of new staff;
• Perform and promote interdepartmental / multidisciplinary integration and collaboration to enhance the continuity of care including Behavioral Health and Long Term Services & Supports for Molina members. Oversees Interdisciplinary Care Team meetings;
• Responsible for supervision and coordination of daily integrated healthcare service activities;
• Ensure adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators;
• Collate and report on Care Access and Monitoring statistics including plan utilization, staff productivity, cost effective utilization of services, management of targeted member population, and triage activities;
• Ensure completion of staff quality audit reviews. Evaluate services provided and outcomes achieved and recommends enhancements / improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines;
• Maintain professional relationships with provider community and internal and external customers while identifying opportunities for improvement.

Requirements:

• Managed healthcare experience (5+ years);
• Experience in one or more of the following areas: utilization management, case management, care transition and/or disease management (3+ years);
• Healthcare or health plan supervisory or managerial experience, including oversight of clinical staff (2+ years);
• Experience working within applicable state, federal, and third party regulations;
• Supervisory/management experience in a managed healthcare environment;
• Medicaid/Medicare Population experience with increasing responsibility;
• Clinical nursing experience;
• Registered Nurse or equivalent combination of Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license;
• Valid driver's license with good driving record;
• Bachelor's or Master's Degree in Nursing, Gerontology, Public Health, Social Work or related field (preferred).

If this job is not for you, earn a $2,100.00 referral bonus in cash by referring a Candidate or a Client to us. Vitaver Referral Program is one of the most generous on the market!

Please feel free to apply directly and contact me with your questions at [email protected]