Coe Cm Director, (Rn Required)

10+ years

Not Disclosed

Remote

10 Feb. 13, 2025

Job Description

Job Type: Full Time Education: BBA/MBA/B.Sc./M.Sc./B.Pharm/M.Pharm/Life science Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Clinical Operations Director - Clinical Center of Excellence (RN Required)
Molina Healthcare
Various Locations: Nationwide

Job ID: 2029135
Compensation: $88,453 - $206,981 / Annual (Actual compensation may vary based on location, experience, education, and skill level)

Job Summary:

Molina Healthcare is seeking a Clinical Operations Director for the Clinical Center of Excellence (COE), which supports the company in driving clinical excellence and delivering high-value, efficient services across Molina Health Plans & Segments. In this leadership role, you will be responsible for establishing best practices, driving standardization, and achieving clinical results across the organization. The Director will be key to overseeing case management standards, performance monitoring, and the transformation of case management models.

Key Responsibilities:

Review and establish case management standards, processes, and best practices to enhance clinical excellence and quality across all Molina Health Plans and Segments.
Identify and support case management best practices across various plans and Lines of Business while ensuring standardization.
Monitor and track Clinical Management Key Performance Indicators (KPIs) at both plan and enterprise levels, addressing performance drivers with the Clinical Analytics, Market Engagement team, and Clinical Programs leadership.
Collaborate with other COE leaders (e.g., UM, LTSS, BH, Quality, Network, Government Contracts, etc.) to support integrated case management models and foster operational improvements.
Lead and govern operational and strategic projects, escalate gaps and barriers to senior management as needed.
Supervise one or more Program Managers, as necessary.

Required Qualifications:

Bachelor’s Degree in a healthcare-related field, or an equivalent combination of education, experience, and/or a Nursing license.
7+ years of managed healthcare experience with line management responsibility in clinical operations.
Strong understanding of state, federal, and third-party regulations.
An active, unrestricted, and in-good-standing RN License (if applicable).

Preferred Qualifications:

10+ years of managed care experience.
Experience with operational and process improvement.
Bachelor's degree in Nursing or Master's degree in Business, Social Work, or another healthcare-related field.
Utilization Management Certification (CPHM) or Certified Professional in Health Care Quality (CPHQ), or other relevant certifications.

About Molina Healthcare:

Molina Healthcare is a nationwide Fortune 500 organization that provides quality healthcare to individuals receiving government assistance. With a mission to make a difference in the lives of others, Molina Healthcare offers a highly engaged workforce and meaningful opportunities within a team-oriented environment.

What We Offer:

Competitive Benefits and Compensation Package
Equal Opportunity Employer (EOE)

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Coe Cm Director, (Rn Required)

Job Description

Job Summary:

Key Responsibilities:

Required Qualifications:

Preferred Qualifications:

About Molina Healthcare:

What We Offer:

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