2030879
Job Description
For this position we are seeking a Licensed Masters Level social worker with a current active license for state of OHIO or RN who must be licensed in OH RN license.
The CM Delegation Liaison will support the OH health population. Preferred experience with MyCare. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role. Good analytical thought process is important to be successful in this role.
WORK SCHEDULE: Monday thru Friday 8:00 AM to 5:00 PM EST
Travel Required (Meeting with the AAA’s in the community)
Home office with internet connectivity of high speed required.
Job Summary
Provides clinical liaison support for delegation oversight activities in conjunction with enterprise partners and multidisciplinary team coordinating integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 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.
ESSENTIAL JOB DUTIES:
- In conjunction with the enterprise delegation oversight team: coordinates, conducts, and documents pre-delegation, ongoing and annual assessments to determine compliance with delegated functions.
- In conjunction with enterprise delegation oversight team, supports the implementation of newly identified delegates for care management.
- Serves as subject matter expert for local health plan state provider agreement, National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), policies and procedures, quick reference guides (QRGs), audit tools and additional requirements during implementations. Attends all implementation meetings and actively participates for seamless launch.
- In conjunction with enterprise delegation oversight team, develops, implements, and tracks corrective action plans for any delegates identified as out of compliance with delegated responsibilities including timely follow-up actions related to the corrective action plan (CAP).
- Performs ongoing monitoring of the delegates to ensure compliance with required reporting and escalates identified issues to appropriate health care services leadership.
- Maintains ongoing communication with delegates and acts as liaison between Molina and delegates by responding to questions, and providing guidance including education and re-education on delegated functions as needed.
- Educates delegate on an ongoing basis related to Molina health care services programs and value added benefits available in the local market to assist Molina members meet their needs.
- Attend joint operation committee (JOC) meetings as required.
- Facilitates, coordinates, submits, reviews, edits, and tracks communication request forms to Molina communications team in support of member materials related to the delegates in order to facilitate state submissions and approvals.
- Remains current and knowledgeable on regulatory changes and industry requirements.
- Collaborates with leadership and enterprise delegation oversight team to design workplans, workflows, etc. as needed.
- Collaborates with internal business partners related to the delegates; includes nurses, care managers, leadership and enterprise delegation oversight staff as needed/required.
- Coordinates with care managers in behavioral health to provide consultation, resources and recommendations to vendors as needed.
- Assists in preparation of documents for utilization management, care management, state, CMS, NCQA and other regulatory audits as needed.
Local travel of up to 40% may be required, depending on assigned delegates, state-specific regulations, and location
REQUIRED QUALIFICATIONS:
- At least 3 years’ health care experience in care management, utilization management, behavioral health, medical, and/or managed care setting, or equivalent combination of relevant education and experience.
- Registered Nurse (RN), Licensed Social Worker (LSW), or Licensed Independent Social Worker (LISW). License must be active and unrestricted in state of practice.
- Experience supporting clinical delegation oversight activities.
- Strong verbal and written communication skills.
- Proficient computer skills, including Microsoft Office.
- Problem-solving and organizational skills.
- Strong interpersonal skills.
PREFERRED QUALIFICATIONS:
- Certified Case Manager (CCM).
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.
Pay Range: $54,922 – $107,099 / ANNUAL
*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 Type: Full Time