Senior Consultant, Clinical Performance

JOB DESCRIPTION Job Summary

Provides senior level clinical subject matter expertise in execution of clinical operations transformations and performance and process improvement initiatives designed to increase operational efficiencies. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Assesses business and operational needs for opportunities to improve efficiency, productivity, effectiveness and accuracy.
• Determines process and program support needs - ensuring process/program needs are appropriately communicated (written and verbal) to process owners and leadership.
• Drives process changes by integrating new processes with existing ones through direct coaching and mentoring of impacted business teams.
• Conducts real-time technology and operational walkthroughs as an immersive coaching clinical subject matter expert, and provides interim stabilization support as needed.
• Uses clinical expertise to identify operating processes that are necessary to operate in a specific market, and processes that can be utilized across the enterprise.
• Reviews, researches, analyzes and evaluates information to assess compliance between a process or function and the corresponding written documentation.
• Uses analytical skills to identify variances.
• Uses problem-solving skills and business knowledge to make recommendations for process remediations or improvements.
• Participates in interview process for staff to assess internal clinical business processes within a department or function, and ensure compliance with existing organizational policies and procedures, standard operating procedures (SOPs) and other internal guidelines.
• Documents and disseminates assessment outcomes and recommendations.
• Conducts meetings and disseminates communications related to process and program needs, including internal action planning and process improvement activities to leadership and staff.
• Uses understanding of key revenue levers, cost drivers and customer satisfaction impacts of business processes, to optimize and improve business processes and productivity.
• Employs change management techniques to prepare the business for successful organizational change initiatives.

Required Qualifications

• At least 6 years of experience in health care, preferably in a clinical consultancy process improvement capacity, or equivalent combination of relevant education and experience.
• Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Licensed Practical Social Worker (LPC), Licensed Marriage and Family Therapist (LMFT), or Licensed Mental Health Counselor (LMHC). License must be active and unrestricted in state of practice.
• Understanding of clinical operations including utilization management and care management.
• Ability to provide hands-on, immersive and directed support for identified business improvement initiatives.
• Experience providing coaching, development and operational feedback to individuals and teams.
• Experience using business knowledge to make recommendations for process remediation or improvement.
• Strong leadership qualities and ability to lead and achieve results.
• Excellent verbal and written communications skills.
• Microsoft Office suite/applicable computer programs proficiency.

Preferred Qualifications

• LEAN or Six Sigma certification.
• Experience tracking and maintaining quality metrics.

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