Clinical Design Specialist ( RN- Pediatrics)

JOB DESCRIPTION

Job Summary

Provides subject matter expertise and leadership in clinical design and population health initiatives, supporting execution/operationalization and implementation, providing evaluation and support for post-implementation process, and ensuring compliance with regulatory and internal standards, practices, policies, and contractual commitments. Contributes to the overarching strategy in providing quality and cost-effective member care to single and multiple member population with a focus on pediatric population health and wellbeing. 

Essential Job Duties

• Supports Population Health Transformation and integrated clinical model concept design.
• Lead clinical design and population health projects: Collaboratively plan and execute initiatives that strengthen care management, transitions of care, and population health strategies across multiple markets.
• Develop and standardize workflows: Design and implement clinical workflows, tools, and protocols that promote whole-person, timely, and coordinated care.
• Drive process improvement and change management: Identify opportunities for efficiency and quality improvement, ensuring alignment with organizational goals and compliance requirements.
• Serve as a clinical subject matter expert: Provide guidance on best practices for care management, including cross functional teams such as utilization management, and quality.
• Communicate and align strategy: Partner with stakeholders to share clinical and operational needs into actionable requirements, ensuring consistent messaging and adoption.
• Create supporting documentation: Develop business requirements, test plans, training materials, and other resources to support program execution and sustainability.
•  Collaboratively 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.
• Provides ongoing communication related to program goals, evaluation, and support to ensure compliance with standardized protocols and processes.
• May engage and oversee the work of external vendors. 

Required Qualifications

• At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience.
• Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Licensed Clinicians to include backgrounds such as MSW, LCSWs etc.
• Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates.
• If licensed, license must be active and unrestricted in state of practice.
• Strong analytical and problem-solving skills.
• Strong organizational and time-management skills.
• Ability to work in a cross-functional, professional environment.
• Experience working within applicable state, federal, and third-party regulations.
• Strong verbal and written communication skills.
• Microsoft Office program proficiency, and ability to navigate online portals and databases.
   

Preferred Qualifications

• Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
• Experience creating executive summaries and decks as well as comfort presenting to varying stakeholders and audiences, including executive leadership
• Clinical nursing experience
•  Leadership and change management experience.
• Medicaid/Medicare/Duals population experience.
• Six Sigma Green Belt or higher certification
• Pediatric experience in a children's hospital or specialty medical setting
• Strong command of writing and editing.

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.