About Us

Molina Healthcare Inc., is among the most experienced managed healthcare companies serving patients who have traditionally faced barriers to quality healthcare-including individuals covered under Medicaid, the Healthy Families Program, the State Children's Health Insurance Program (SCHIP) and other government-sponsored health insurance programs. Molina has health plans in California, Michigan, New Mexico, Utah, Ohio, Texas, Florida, Missouri and Washington as well as 19 primary care clinics located in Northern and Southern California. The company's corporate headquarters are in Long Beach, California.

Molina Healthcare of Michigan, Inc. is the largest Medicaid Healthcare Plan in the State of Michigan, with over 210,000 members, 1,950 PCP's, 3,400 Specialists, 750 Ancillaries, 50 Urgent Care Sites and over 50 Hospitals. Molina Healthcare of Michigan currently has an "excellent" accreditation status with NCQA. Offices located in Michigan are in Troy, Detroit and Grand Rapids. Molina Healthcare of Michigan employs approximately 275 employees. Please visit our website at www.molinahealthcare.com to learn more about Molina Healthcare.

About the Position

• Oversee, coordinate and monitor all UM team activities to facilitate proactive care coordination.

• Oversee and evaluate team members in the performance of various UM activities including pre-service review, admission review, concurrent review, discharge planning, case management (including the proactive identification of members, detailed assessment of member needs, development/documentation of an individualized plan of care, implementation of the plan of care, coordination of health services, monitoring of the plan, evaluation of plan appropriateness, and measurement of outcomes) and appeals management. 

• Ensure adequate staffing and service levels, and maintains customer satisfaction by implementing and monitoring staff productivity and performance indicators. Maintains effective team member relations.

• Conducts regular staff meetings

• Responsible for new employee selection and orientation.

• Conducts performance evaluations in a timely manner

• Provides coaching, counseling and employee development and meets individually with staff at least monthly.

• Provides appropriate recognition for exceptional employee performance.

• Assists team members in improving utilization and case management skills, creativity and problem solving.

• Consults with UM Director to implement corrective action or disciplinary measures necessary to improve staff performance.

• Supports UM program related initiatives.

• Manages and completes assigned work plan objectives and projects on a timely basis.

• Evaluates the effectiveness of UM interventions including outcomes assessment.

• Represents the UM Department by participating on committees, task forces, work groups and multidisciplinary teams 

• Maintains professional relationships with provider community and external customers and identifies opportunities for improvement.

• Works closely with Provider Services, Disease Management, Pharmacy, Claims, and Member Services.

• Meet with providers as necessary to collaborate on UM initiatives including attendance at regular meetings.

• Participates in the development of policies and oversees staff activities to ensure compliance with regulatory and accrediting standards.

• Provides reports of compliance and other UM activities

• Required:    Valid State of Michigan RN License
• Required:    Bachelors degree in Nursing or related field required. (Degree may be waived in lieu of experience)
• Required:    3-plus years clinical nursing experience
• Required:    2-plus years utilization management experience in a managed care setting
• Required:    2- plus years case management experience
• Required:    Strong leadership and communication skills
• Required:    Case Management program development experience
• Required:    Project management experience
• Required:    Experience with case management information systems
• Required:    Experience with Medicare programs in a managed care environment
• Required:    Knowledge of applicable state, federal and third party regulations and standards
• Preferred:   Previous Medicaid and/or government program experience
• Preferred:   Masters degree in Nursing or related field
• Preferred:   Case Mgr. (CCM), UM (CPUM) or other certification

Molina Healthcare offers competitive benefits and compensation package.

To be considered, your resume must meet specific position requirements.