Nursing Director jobs at HCA Healthcare

This is a full time Nursing (RN) Director responsible for the inpatient Medical Surgical department at Physicians Regional Collier in Naples, FL. Benfits include: Medical, Dental, Company Match 401k, competative Paid Time Off, and more! Job Summary The Director, Med/Surg, is responsible for the overall leadership and management of the medical-surgical department, ensuring the delivery of safe, high-quality patient care and operational excellence. This role provides strategic direction, oversees departmental operations, and ensures compliance with healthcare regulations and organizational objectives. The Director fosters a culture of collaboration and continuous improvement while supporting staff development and patient satisfaction. Essential Functions Oversees clinical operations in the medical-surgical department, ensuring that patient care is delivered safely, efficiently, and in alignment with evidence-based practices and regulatory standards. Collaborates with physicians, nursing staff, and multidisciplinary teams to ensure seamless coordination of patient care across the continuum. Manages departmental budgets, staffing, and resource allocation to maintain financial efficiency while meeting patient care needs and maintaining high standards of service. Monitors key performance indicators and quality metrics, identifying opportunities for improvement and leading initiatives to optimize patient outcomes and departmental performance. Facilitates open communication and collaboration between clinical staff, administration, and external stakeholders to address patient care needs and operational challenges. Responds promptly to patient care concerns, complaints, and incidents, conducting investigations and implementing corrective actions as necessary. Maintains up-to-date knowledge of industry trends, emerging clinical practices, and regulatory changes, ensuring the department adapts to evolving healthcare environments. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Leadership Responsibilities Supervision and Staff Management Provides leadership, mentorship and professional development opportunities for departmental staff. Schedules employees to ensure effective use of resources. Consults with leadership on any potential staffing issues. Conducts performance evaluations, sets goals and provides feedback to staff on their performance and development. Strategic Planning and Financial Oversight Collaborates with hospital leadership to set the strategic direction for the department, including budgeting, resource allocation and long-term planning. Monitors expenditures, ensuring cost-effective delivery of services. Evaluates and implements new technologies to enhance operational efficiency. Develops and implements departmental policies and procedures and protocols to optimize quality and overall efficiencies. Quality Assurance and Regulatory Compliance Ensures compliance with all relevant regulatory bodies. May oversee the accreditation process with relevant agencies ensuring that services meet or exceed industry standards. Participates in audits, inspections and accreditation processes as applicable. Follows established quality control practices to ensure accuracy, consistency and safety. Collaboration and Communication Works closely with leadership teams to coordinate and improve service delivery. Stays up-to-date with industry advancements, new technologies, and regulatory changes. Staff Responsibilities May work in a staff role, when required. Ensures that duties and responsibilities are fulfilled while meeting all competencies established for that job. Qualifications Bachelor's Degree in relevant field required or Seven (7) plus years of direct experience in lieu of a Bachelor's degree required Master's Degree preferred 3-5 years of experience in closely related field with Bachelor's degree required 3-5 years of previous leadership experience preferred Knowledge, Skills and Abilities Strong leadership, organizational, and communication skills. Ability to collaborate with interdisciplinary teams and manage cross-functional relationships. Foster a positive work environment that promotes teamwork, professionalism, and continuous improvement. Communicate effectively with leadership, team members, and stakeholders. Ability to work effectively with others, delegate responsibilities, and independently manage tasks while meeting established deadlines. Problem-solving and critical thinking skills. In depth knowledge of industry best practices and regulatory compliance (if applicable). Strong organizational and time management skills. Proficiency with Google and Microsoft platforms, healthcare software systems, and data analysis tools. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure required Basic Life Support Program (BLS) - American Heart Association required INDLEAD

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Determines appropriateness and medical necessity of health care services provided to plan members. - Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. -Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. - Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. - Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. - Participates in and maintains the integrity of the appeals process, both internally and externally. - Responsible for investigation of adverse incidents and quality of care concerns. - Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. - Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. - Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. - Reviews quality referred issues, focused reviews and recommends corrective actions. - Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. - Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. - Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. - Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. - Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. - Ensures medical protocols and rules of conduct for plan medical personnel are followed. - Develops and implements plan medical policies. - Provides implementation support for quality improvement activities. - Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. - Fosters clinical practice guideline implementation and evidence-based medical practices. - Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. - Actively participates in regulatory, professional and community activities. Required Qualifications - At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. - Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice. - Board certification. - Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. - Ability to work cross-collaboratively within a highly matrixed organization. - Strong organizational and time-management skills. - Ability to multi-task and meet deadlines. - Attention to detail. - Critical-thinking and active listening skills. - Decision-making and problem-solving skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications - Experience with utilization/quality program management. - Managed care experience. - Peer review experience. - Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $161,914.25 - $315,733 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**Per Diem Hospice Medical Directorin Beautiful Northern, CO** **Remote Only & Flexible Schedule** **BANNER HEALTH and the Home Care & Hospice Division** , one of the countrys premier, nonprofit health care networks with more than 1,500 physicians and advance practice providers, **has an excellent opportunity for a compassionate, skilled clinician to join our interdisciplinary team!This position serves the growing community in Northern Colorado in partnership with the current care team.** Utilizing a multidisciplinary approach, the qualified candidate will provide remote support to the Home Care & Hospice team of Advanced Practice Providers. **Position Requirements and Information:** + BC/BE in a relevant specialty + Fellowship training in Hospice & Palliative Medicine - NOT REQUIRED + Experience preferred, new graduates also welcome to apply + Flexible schedule primarily providing back-up coverage for the acting Medical Director **Compensation & Benefits:** + **$140/hr** + Malpractice and Tail Coverage **About the area:** With more than 300 days of sunshine, Northern Colorado is one of the best places to live and work offering spectacular views along the Rocky Mountain Front Range, great weather, endless recreational activities, cultural amenities, education, and professional opportunities. + Within one hour of majestic Rocky Mountain National Park & 90 minutes to world-class ski resorts + Numerous outdoor activities including golf, biking, hiking, camping, rock climbing, hunting, and fishing + Thriving cultural and retail sectors + Highly educated workforce & broad-based business sector leading to substantial growth along the front range + Variety of public and private education options for K-12 and easy access to three major universities **PLEASE SUBMIT YOUR CV TODAY FOR IMMEDIATE CONSIDERATION** As an equal opportunity employer, Banner Health values culture and encourages applications from individuals with varied experiences and backgrounds. Banner Health is an EEO Employer. POS15101 Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability.

Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. * Facilitates comprehensive waiver enrollment and disenrollment processes. * Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. * Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. * Assesses for medical necessity and authorizes all appropriate waiver services. * Evaluates covered benefits and advises appropriately regarding funding sources. * Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. * Identifies critical incidents and develops prevention plans to assure member health and welfare. * May provide consultation, resources and recommendations to peers as needed. * Care manager RNs may be assigned complex member cases and medication regimens. * Care manager RNs may conduct medication reconciliation as needed. * 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications * At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice. * Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. * Ability to operate proactively and demonstrate detail-oriented work. * Demonstrated knowledge of community resources. * Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. * Ability to work independently, with minimal supervision and demonstrate self-motivation. * Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. * Ability to develop and maintain professional relationships. * Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. * Excellent problem-solving and critical-thinking skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. * In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications * Certified Case Manager (CCM). * Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $23.76 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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. Locations: Ohio Central, NW and WC Region: Delaware, Franklin, Madison, Pickaway, Union, Columbus, Clark, Montgomery, Dayton, Toledo, Lucas County Positions: Community Well, and Nursing Facility Care Management. KNOWLEDGE/SKILLS/ABILITIES * Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment. * Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals. * Conducts face-to-face or home visits as required. * Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Maintains ongoing member case load for regular outreach and management. * Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for Molina members. * Facilitates interdisciplinary care team meetings and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care, provides care coordination and assistance to member to address concerns. * 25- 40% local travel required. * RNs provide consultation, recommendations and education as appropriate to non-RN case managers. * RNs are assigned cases with members who have complex medical conditions and medication regimens * RNs conduct medication reconciliation when needed. JOB QUALIFICATIONS Required Education Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred. Required Experience 1-3 years in case management, disease management, managed care or medical or behavioral health settings. Required License, Certification, Association Active, unrestricted State Registered Nursing (RN) 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 Bachelor's Degree in Nursing Preferred Experience 3-5 years in case management, disease management, managed care or medical or behavioral health settings. Preferred License, Certification, Association Active, unrestricted Certified Case Manager (CCM) 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. #PJHS2 Pay Range: $26.41 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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. Locations: Ohio Central, NW and WC Region: Delaware, Franklin, Madison, Pickaway, Union, Columbus, Clark, Montgomery, Dayton, Toledo, Lucas County Positions: Community Well, and Nursing Facility Care Management. KNOWLEDGE/SKILLS/ABILITIES * Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment. * Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals. * Conducts face-to-face or home visits as required. * Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Maintains ongoing member case load for regular outreach and management. * Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for Molina members. * Facilitates interdisciplinary care team meetings and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care, provides care coordination and assistance to member to address concerns. * 25- 40% local travel required. * RNs provide consultation, recommendations and education as appropriate to non-RN case managers. * RNs are assigned cases with members who have complex medical conditions and medication regimens * RNs conduct medication reconciliation when needed. JOB QUALIFICATIONS Required Education Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred. Required Experience 1-3 years in case management, disease management, managed care or medical or behavioral health settings. Required License, Certification, Association Active, unrestricted State Registered Nursing (RN) 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 Bachelor's Degree in Nursing Preferred Experience 3-5 years in case management, disease management, managed care or medical or behavioral health settings. Preferred License, Certification, Association Active, unrestricted Certified Case Manager (CCM) 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. #PJHS2 Pay Range: $26.41 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

JOB DESCRIPTION Job SummaryLeads and manages a team of medical directors delivering oversight and expertise in appropriateness and medical necessity of services provided to members - ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Leads a team of medical directors responsible for assessing appropriateness and medical necessity of health care services provided to plan members. - Provides leadership and expertise in performance of prior authorization, inpatient concurrent review, discharge planning, care management and interdisciplinary care team (ICT) activities. - Recruits, hires, trains, mentors and develops medical director staff as needed. - Ensures that authorization decisions are rendered by qualified medical personnel and without hindrance due to fiscal or administrative incentives. - Analyzes data and identifies medical cost-savings and quality improvement opportunities. - Accounts for regulatory and accreditation performance of assigned team and responds to inquiries, issues and complaints from government and accreditation regulators. - Develops medical policies and procedures as needed. - Conducts peer review processes. Required Qualifications - At least 8 years of relevant experience, including clinical practice experience, and at least 2 years as a medical director in managed care setting supporting utilization management/quality management initiatives, or equivalent combination of relevant education and experience. - At least 3 years management/leadership experience. - Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice. - Board Certification. - Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. - Demonstrated ability to make strategic decisions. - Knowledge of health care regulatory and legislative processes, including ability to read and interpret legislation. - Experience gaining consensus, and collaborating in a highly matrixed organization. - Experience demonstrating strong leadership, communication, consensus building, collaboration and financial acumen abilities. - Evidence-based clinical criteria competency. - Peer review, medical policy/procedure development, and provider contracting experience. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other Health care or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $214,132 - $417,557 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job SummaryLeads and manages a team of medical directors delivering oversight and expertise in appropriateness and medical necessity of services provided to members - ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Leads a team of medical directors responsible for assessing appropriateness and medical necessity of health care services provided to plan members. - Provides leadership and expertise in performance of prior authorization, inpatient concurrent review, discharge planning, care management and interdisciplinary care team (ICT) activities. - Recruits, hires, trains, mentors and develops medical director staff as needed. - Ensures that authorization decisions are rendered by qualified medical personnel and without hindrance due to fiscal or administrative incentives. - Analyzes data and identifies medical cost-savings and quality improvement opportunities. - Accounts for regulatory and accreditation performance of assigned team and responds to inquiries, issues and complaints from government and accreditation regulators. - Develops medical policies and procedures as needed. - Conducts peer review processes. Required Qualifications - At least 8 years of relevant experience, including clinical practice experience, and at least 2 years as a medical director in managed care setting supporting utilization management/quality management initiatives, or equivalent combination of relevant education and experience. - At least 3 years management/leadership experience. - Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice. - Board Certification. - Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. - Demonstrated ability to make strategic decisions. - Knowledge of health care regulatory and legislative processes, including ability to read and interpret legislation. - Experience gaining consensus, and collaborating in a highly matrixed organization. - Experience demonstrating strong leadership, communication, consensus building, collaboration and financial acumen abilities. - Evidence-based clinical criteria competency. - Peer review, medical policy/procedure development, and provider contracting experience. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other Health care or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $214,132 - $417,557 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job SummaryLeads and manages a team of medical directors delivering oversight and expertise in appropriateness and medical necessity of services provided to members - ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Leads a team of medical directors responsible for assessing appropriateness and medical necessity of health care services provided to plan members. - Provides leadership and expertise in performance of prior authorization, inpatient concurrent review, discharge planning, care management and interdisciplinary care team (ICT) activities. - Recruits, hires, trains, mentors and develops medical director staff as needed. - Ensures that authorization decisions are rendered by qualified medical personnel and without hindrance due to fiscal or administrative incentives. - Analyzes data and identifies medical cost-savings and quality improvement opportunities. - Accounts for regulatory and accreditation performance of assigned team and responds to inquiries, issues and complaints from government and accreditation regulators. - Develops medical policies and procedures as needed. - Conducts peer review processes. Required Qualifications - At least 8 years of relevant experience, including clinical practice experience, and at least 2 years as a medical director in managed care setting supporting utilization management/quality management initiatives, or equivalent combination of relevant education and experience. - At least 3 years management/leadership experience. - Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice. - Board Certification. - Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. - Demonstrated ability to make strategic decisions. - Knowledge of health care regulatory and legislative processes, including ability to read and interpret legislation. - Experience gaining consensus, and collaborating in a highly matrixed organization. - Experience demonstrating strong leadership, communication, consensus building, collaboration and financial acumen abilities. - Evidence-based clinical criteria competency. - Peer review, medical policy/procedure development, and provider contracting experience. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other Health care or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $214,132 - $417,557 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Determines appropriateness and medical necessity of health care services provided to plan members. - Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. -Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. - Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. - Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. - Participates in and maintains the integrity of the appeals process, both internally and externally. - Responsible for investigation of adverse incidents and quality of care concerns. - Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. - Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. - Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. - Reviews quality referred issues, focused reviews and recommends corrective actions. - Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. - Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. - Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. - Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. - Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. - Ensures medical protocols and rules of conduct for plan medical personnel are followed. - Develops and implements plan medical policies. - Provides implementation support for quality improvement activities. - Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. - Fosters clinical practice guideline implementation and evidence-based medical practices. - Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. - Actively participates in regulatory, professional and community activities. Required Qualifications - At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. - Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice. - Board certification. - Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. - Ability to work cross-collaboratively within a highly matrixed organization. - Strong organizational and time-management skills. - Ability to multi-task and meet deadlines. - Attention to detail. - Critical-thinking and active listening skills. - Decision-making and problem-solving skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications - Experience with utilization/quality program management. - Managed care experience. - Peer review experience. - Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $161,914.25 - $315,733 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provisions of medical staff services. Maintains a working knowledge of applicable national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the following states: AZ, FL, TX, NV, WA, CT, KY, MS, NM, CA **Job Duties** + Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership position relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. + Reviews quality referred issues, focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as Credentialing, P&T and others as directed by the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the denial process. + Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. + Ensures that medical decisions are rendered by qualified medical personnel, not influenced by fiscal or administrative management considerations, and that the care provided meets the standards for acceptable medical care. + Ensures that medical protocols and rules of conduct for plan medical personnel are followed. + Develops and implements plan medical policies. + Provides implementation support for Quality Improvement activities. + Stabilizes, improves and educates the Primary Care Physician and Specialty networks. Monitors practitioner practice patterns and recommends corrective actions if needed. + Fosters Clinical Practice Guideline implementation and evidence-based medical practice. + Utilizes IT and data analysts to produce tools to report, monitor and improve Utilization Management. + Actively participates in regulatory, professional and community activities. **JOB QUALIFICATIONS** **REQUIRED EDUCATION:** + Doctorate Degree in Medicine + Board Certified or eligible in a primary care specialty **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + 3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. + Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen. + Knowledge of applicable state, federal and third party regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Current state Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare. **PREFERRED EDUCATION:** Master's in Business Administration, Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review, medical policy/procedure development, provider contracting experience. + Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines. + Experience in Utilization/Quality Program management + HMO/Managed care experience **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Board Certification (Primary Care preferred). **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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. \#PJHS \#LI-AC1 Pay Range: $161,914.25 - $315,733 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization management and case management programs for mental health and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management policies and procedures to improve quality outcomes and decrease costs. - Provide regional medical necessity reviews and cross coverage - Standardizes UM practices and quality and financial goals across all LOBs - Responds to BH-related RFP sections and review BH portions of state contracts - Assist the BH MD lead trainers in the development of enterprise-wide teaching on psychiatric diagnoses and treatment - Provides second level BH clinical reviews, BH peer reviews and appeals - Supports BH committees for quality compliance. - Implements clinical practice guidelines and medical necessity review criteria - Tracks all clinical programs for BH quality compliance with NCQA and CMS - Assists with the recruitment and orientation of new Psychiatric MDs - Ensures all BH programs and policies are in line with industry standards and best practices - Assists with new program implementation and supports the health plan in-source BH services - Additional duties as assigned **Job Qualifications** **REQUIRED EDUCATION:** - Doctorate Degree in Medicine (MD or DO) with Board Certification in Psychiatry **REQUIRED EXPERIENCE:** - 2 years previous experience as a Medical Director in clinical practice - 3 years' experience in Utilization/Quality Program Management - 2+ years HMO/Managed Care experience - Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen. - Knowledge of applicable state, federal and third-party regulations **Required License, Certification, Association** Active and unrestricted State (TX) Medical License, free of sanctions from Medicaid or Medicare. **Preferred Experience** - Peer Review, medical policy/procedure development, provider contracting experience. - Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines. 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. \#PJHS \#LI-AC1 Pay Range: $161,914.25 - $315,733 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs. - Facilitates behavioral health-related regional medical necessity reviews and cross coverage. - Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses. - Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts. - Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment. - Provides second level behavioral health clinical reviews, peer reviews and appeals. - Supports behavioral health committees for quality compliance. - Implements behavioral health specific clinical practice guidelines and medical necessity review criteria. - Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). - Assists with the recruitment and orientation of new psychiatric medical directors. - Ensures all behavioral health programs and policies are in line with industry standards and best practices. - Assists with new program implementation and supports for health plan in-source behavioral health services. Required Qualifications - At least 3 of relevant experience, including 2 years of medical practice experience in psychiatry/behavioral health, or equivalent combination of relevant education and experience. - Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice. - Board Certification in Psychiatry. - Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. - Ability to work cross-collaboratively within a highly matrixed organization. - Strong organizational and time-management skills. - Ability to multi-task and meet deadlines. - Attention to detail. - Critical-thinking and active listening skills. - Decision-making and problem-solving skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications - Experience with utilization/quality program management. - Managed care experience. - Peer review experience. - Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. \#PJHS \#LI-AC1 \#HTF To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $161,914.25 - $315,733 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provisions of medical staff services. Maintains a working knowledge of applicable national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the following states: AZ, FL, TX, NV, WA, CT, KY, MS, NM, CA **Job Duties** + Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership position relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. + Reviews quality referred issues, focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as Credentialing, P&T and others as directed by the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the denial process. + Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. + Ensures that medical decisions are rendered by qualified medical personnel, not influenced by fiscal or administrative management considerations, and that the care provided meets the standards for acceptable medical care. + Ensures that medical protocols and rules of conduct for plan medical personnel are followed. + Develops and implements plan medical policies. + Provides implementation support for Quality Improvement activities. + Stabilizes, improves and educates the Primary Care Physician and Specialty networks. Monitors practitioner practice patterns and recommends corrective actions if needed. + Fosters Clinical Practice Guideline implementation and evidence-based medical practice. + Utilizes IT and data analysts to produce tools to report, monitor and improve Utilization Management. + Actively participates in regulatory, professional and community activities. **JOB QUALIFICATIONS** **REQUIRED EDUCATION:** + Doctorate Degree in Medicine + Board Certified or eligible in a primary care specialty **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + 3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. + Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen. + Knowledge of applicable state, federal and third party regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Current state Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare. **PREFERRED EDUCATION:** Master's in Business Administration, Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review, medical policy/procedure development, provider contracting experience. + Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines. + Experience in Utilization/Quality Program management + HMO/Managed care experience **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Board Certification (Primary Care preferred). **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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. \#PJHS \#LI-AC1 Pay Range: $161,914.25 - $315,733 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Determines appropriateness and medical necessity of health care services provided to plan members. - Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. -Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. - Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. - Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. - Participates in and maintains the integrity of the appeals process, both internally and externally. - Responsible for investigation of adverse incidents and quality of care concerns. - Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. - Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. - Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. - Reviews quality referred issues, focused reviews and recommends corrective actions. - Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. - Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. - Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. - Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. - Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. - Ensures medical protocols and rules of conduct for plan medical personnel are followed. - Develops and implements plan medical policies. - Provides implementation support for quality improvement activities. - Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. - Fosters clinical practice guideline implementation and evidence-based medical practices. - Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. - Actively participates in regulatory, professional and community activities. Required Qualifications - At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. - Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice. - Board certification. - Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. - Ability to work cross-collaboratively within a highly matrixed organization. - Strong organizational and time-management skills. - Ability to multi-task and meet deadlines. - Attention to detail. - Critical-thinking and active listening skills. - Decision-making and problem-solving skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications - Experience with utilization/quality program management. - Managed care experience. - Peer review experience. - Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $161,914.25 - $315,733 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs. - Facilitates behavioral health-related regional medical necessity reviews and cross coverage. - Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses. - Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts. - Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment. - Provides second level behavioral health clinical reviews, peer reviews and appeals. - Supports behavioral health committees for quality compliance. - Implements behavioral health specific clinical practice guidelines and medical necessity review criteria. - Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). - Assists with the recruitment and orientation of new psychiatric medical directors. - Ensures all behavioral health programs and policies are in line with industry standards and best practices. - Assists with new program implementation and supports for health plan in-source behavioral health services. Required Qualifications - At least 3 of relevant experience, including 2 years of medical practice experience in psychiatry/behavioral health, or equivalent combination of relevant education and experience. - Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice. - Board Certification in Psychiatry. - Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. - Ability to work cross-collaboratively within a highly matrixed organization. - Strong organizational and time-management skills. - Ability to multi-task and meet deadlines. - Attention to detail. - Critical-thinking and active listening skills. - Decision-making and problem-solving skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications - Experience with utilization/quality program management. - Managed care experience. - Peer review experience. - Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $161,914.25 - $315,733 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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. Positions available in NE Ohio: Cuyahoga, Geauga, Lake, Lorain, Medina and Cleveland KNOWLEDGE/SKILLS/ABILITIES * Completes face-to-face comprehensive assessments of members per regulated timelines. * Facilitates comprehensive waiver enrollment and disenrollment processes. * Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals. * Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members. * Assesses for medical necessity and authorize all appropriate waiver services. * Evaluates covered benefits and advise appropriately regarding funding source. * Conducts face-to-face or home visits as required. * Facilitates interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns. * Identifies critical incidents and develops prevention plans to assure member's health and welfare. * Provides consultation, recommendations and education as appropriate to non-RN case managers * Works cases with members who have complex medical conditions and medication regimens * Conducts medication reconciliation when needed. * 50-75% travel required. JOB QUALIFICATIONS Required Education Graduate from an Accredited School of Nursing Required Experience * At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports. * 1-3 years in case management, disease management, managed care or medical or behavioral health settings. * Required License, Certification, Association * Active, unrestricted State Registered Nursing license (RN) in good standing * If field work is required, 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 Bachelor's Degree in Nursing Preferred Experience * 3-5 years in case management, disease management, managed care or medical or behavioral health settings. * 1 year experience working with population who receive waiver services. Preferred License, Certification, Association Active and unrestricted Certified Case Manager (CCM) 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. #PJHS3 Pay Range: $26.41 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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. Positions available in NE Ohio: Cuyahoga, Geauga, Lake, Lorain, Medina and Cleveland KNOWLEDGE/SKILLS/ABILITIES * Completes face-to-face comprehensive assessments of members per regulated timelines. * Facilitates comprehensive waiver enrollment and disenrollment processes. * Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals. * Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members. * Assesses for medical necessity and authorize all appropriate waiver services. * Evaluates covered benefits and advise appropriately regarding funding source. * Conducts face-to-face or home visits as required. * Facilitates interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns. * Identifies critical incidents and develops prevention plans to assure member's health and welfare. * Provides consultation, recommendations and education as appropriate to non-RN case managers * Works cases with members who have complex medical conditions and medication regimens * Conducts medication reconciliation when needed. * 50-75% travel required. JOB QUALIFICATIONS Required Education Graduate from an Accredited School of Nursing Required Experience * At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports. * 1-3 years in case management, disease management, managed care or medical or behavioral health settings. * Required License, Certification, Association * Active, unrestricted State Registered Nursing license (RN) in good standing * If field work is required, 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 Bachelor's Degree in Nursing Preferred Experience * 3-5 years in case management, disease management, managed care or medical or behavioral health settings. * 1 year experience working with population who receive waiver services. Preferred License, Certification, Association Active and unrestricted Certified Case Manager (CCM) 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. #PJHS3 Pay Range: $26.41 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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. Positions available in NE Ohio: Cuyahoga, Geauga, Lake, Lorain, Medina and Cleveland KNOWLEDGE/SKILLS/ABILITIES * Completes face-to-face comprehensive assessments of members per regulated timelines. * Facilitates comprehensive waiver enrollment and disenrollment processes. * Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals. * Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members. * Assesses for medical necessity and authorize all appropriate waiver services. * Evaluates covered benefits and advise appropriately regarding funding source. * Conducts face-to-face or home visits as required. * Facilitates interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns. * Identifies critical incidents and develops prevention plans to assure member's health and welfare. * Provides consultation, recommendations and education as appropriate to non-RN case managers * Works cases with members who have complex medical conditions and medication regimens * Conducts medication reconciliation when needed. * 50-75% travel required. JOB QUALIFICATIONS Required Education Graduate from an Accredited School of Nursing Required Experience * At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports. * 1-3 years in case management, disease management, managed care or medical or behavioral health settings. * Required License, Certification, Association * Active, unrestricted State Registered Nursing license (RN) in good standing * If field work is required, 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 Bachelor's Degree in Nursing Preferred Experience * 3-5 years in case management, disease management, managed care or medical or behavioral health settings. * 1 year experience working with population who receive waiver services. Preferred License, Certification, Association Active and unrestricted Certified Case Manager (CCM) 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. #PJHS3 Pay Range: $26.41 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.