JOIN MOLINA HEALTHCARE NEAR MIAMI FLORIDA. 

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including BEHAVIORAL HEALTH and LONG TERM CARE, for members with high need potential. HCS STAFF WORK TO ENSURE THAT PATIENTS PROGRESS TOWARD DESIRED OUTCOMES WITH QUALITY CARE THAT IS MEDICALLY APPROPRIATE AND COST-EFFECTIVE BASED ON THE SEVERITY OF ILLNESS AND THE SITE OF SERVICE. KNOWLEDGE/SKILLS/ABILITIES The VP, Healthcare Services is responsible for oversight and management of the state health plan's HEALTHCARE SERVICES (CLINICAL OPERATIONS)teams including UTILIZATION MANAGEMENT (PRIOR-AUTHORIZATION, INPATIENT REVIEW)and CARE MANAGEMENT (CASE/HEALTH MANAGEMENT AND TRANSITION OF CARE). This position WORKS COLLABORATIVELY WITH THE CHIEF MEDICAL OFFICER TO DEVELOP AND IMPLEMENT PROCESSES TO EFFECTIVELY MANAGE CLINICAL POLICIES TO MEET HEALTHCARE COST AND QUALITY TARGETS. • Works with the Healthcare Services management team to achieve successful IMPLEMENTATION OF MOLINA CLINICAL STRATEGY and direction. JOB QUALIFICATIONS REQUIRED EDUCATION Master's Degree or equivalent combination of education and work experience.

REQUIRED EXPERIENCE • 10 years managed care experience with line management responsibility including clinical operations. • Experience working within applicable state, federal, and third party regulations. • Operational and process improvement experience. • Strong communication and teaming/interpersonal skills. • Strong leadership capabilities and ability to initiate and maintain cross-team relationships. • Demonstrated experience meeting Quality Accreditation Standards (NCQA/HEDIS/STARS): nice to have.

PREFERRED EDUCATION

Masters Degree in Business or Healthcare management (i.e. MBA, MHA, MPH). PREFERRED EXPERIENCE Familiarity and experience in the local market desirable. PREFERRED LICENSE NOT REQUIRED, CERTIFICATION, ASSOCIATION Active, unrestricted STATE REGISTERED NURSING (RN) LICENSE in good standing.

For immediate consideration email randerson@careermatchpro.com