Supervisor, Care Review Prior Authorization Remote based in WA

JOB DESCRIPTION

Job Summary

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.

This position will be supporting our Washington State Plan. We are seeking a candidate with a WA state LPN licensure. Candidates with previous prior authorization and MCO experience are highly preferred. Further details to be discussed during our interview process.

Work hours: Monday- Friday 8:00am- 5:00pm PST including rotational holiday and weekend on-call coverage (manager and supervisor will rotate)

Remote position

KNOWLEDGE/SKILLS/ABILITIES

• Oversees an integrated Care Access and Monitoring team responsible for prior authorizations and/or other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time.
• Functions as a hands-on supervisor, coordinating and monitoring clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.
• Manages and evaluates team members in the performance of various utilization management activities; provides coaching, counseling, employee development, and recognition; and assists with selection, orientation and mentoring of new staff.
• Performs and promotes interdepartmental integration and collaboration to enhance the continuity of care including Behavioral Health and Long-Term Care for Molina members.
• Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
• Collates and reports on Care Access and Monitoring statistics including plan utilization, staff productivity, cost effective utilization of services, management of targeted member population, and triage activities.
• Completes staff quality audit reviews. Evaluates 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.
• Provides feedback on annual prior authorization policy changes.
• Ensures prior authorization materials are updated annually and communicated appropriately to Molina providers and staff.
• Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement.

JOB QUALIFICATIONS

Required Education

Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program.

Required Experience

• 3+ years hospital or medical clinic experience.
• 2+ years utilization management experience.
• Experience demonstrating leadership skills.

Required License, Certification, Association

• Active, unrestricted State Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in good standing.
• Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

Associate's or bachelor’s degree in Nursing or related field.

Preferred Experience

• 5 years clinical practice with managed care, hospital nursing or utilization management experience.
• 3+ years supervisory experience in a managed healthcare environment.

Preferred License, Certification, Association

Utilization Management Certification (CPHM).

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Originally posted on Himalayas