RN Program Manager Healthcare Services

Molina Healthcare; Long Beach (CA); On-site; USD 70,000 - 100,000; Full time

Job summary

An established industry player is seeking a dedicated Registered Nurse to join their dynamic team. This role involves managing healthcare service projects, ensuring compliance with regulations, and collaborating with various stakeholders to improve processes. The ideal candidate will have extensive experience in managed healthcare, strong communication skills, and a passion for delivering quality care. This position offers a unique opportunity to make a meaningful impact in the lives of patients while working in a fast-paced environment. If you're ready to take your career to the next level, this is the perfect opportunity for you.

Benefits

Competitive benefits package

Flexible schedule

Professional development opportunities

Health insurance

Retirement plan

Qualifications

• 5+ years of managed healthcare experience required.
• Must be a licensed RN or equivalent with strong project management skills.
• Experience in utilization management or case management is essential.

Responsibilities

• Manage healthcare services projects and programs with cross-functional teams.
• Conduct quality audits and implement quality initiatives.
• Create business requirements and training materials.

Skills

Project Management

Process Improvement

Healthcare Regulations

Communication Skills

Collaboration

Quality Audits

Education

Registered Nurse License

Bachelor's Degree in Nursing

Master's Degree in Nursing or related field

Tools

Business Requirements Documentation

Test Plans

Requirements Traceability Matrix

Job description

JOB DESCRIPTION

For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they reside. Program Manager RN will be supporting our corporate division with Implementations within new and existing health plans. Looking for someone with excellent computer skills including creating configuration documents, business requirements, traceability matrix, test plans. This is a fast-paced position that will require someone who can work multiple projects/tasks simultaneously.

TRAVEL – Must be able to do business travels and go to new markets for implementation when needed.

Schedule: Monday thru Friday 8:00AM to 5:00PM (Must be able to be flexible with schedule)

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.

KNOWLEDGE/SKILLS/ABILITIES

• In collaboration with others, plans and executes internal Healthcare Services projects and programs involving department or cross-functional teams of subject matter experts, delivering products from the design process to completion.
• Manages programs providing ongoing communication of goals, evaluation, and support to ensure compliance with standardized protocols and processes.
• May engage and oversee the work of external vendors.
• Focuses on process improvement, organizational change management, program management and other processes relative to the business.
• Serves as a subject matter expert and leads programs to meet critical needs.
• Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
• Works with operational leaders within the business to provide recommendations for process improvement opportunities.
• Conducts quality audits to assess Molina Healthcare Services staff educational needs and service quality and implement quality initiatives within the department as appropriate.
• Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.

JOB QUALIFICATIONS

Required Education

• Registered Nurse or equivalent combination of Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license.
• OR Bachelor's or master’s degree in Nursing, Gerontology, Public Health, Social Work or related field.

Required Experience

• 5+ years of managed healthcare experience, including 3 or more years in one or more of the following areas: utilization management, case management, care transition and/or disease management.
• Minimum 2 years of healthcare or health plan supervisory or managerial experience, including oversight of clinical staff.
• Experience working within applicable state, federal, and third party regulations.

Required License, Certification, Association

• If licensed, license must be active, unrestricted and 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

Master's Degree preferred.

Preferred Experience

• 3+ years supervisory/management experience in a managed healthcare environment.
• Medicaid/Medicare Population experience with increasing responsibility.
• 3+ years of clinical nursing experience.

Preferred License, Certification, Association

Any of the following:

Certified Case Manager (CCM), Certified Professional in Healthcare Management Certification (CPHM), Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification.

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.