Director, Inpatient Utilization & Care Management

Molina Healthcare; Fresno (CA); Remote; USD 102,000 - 198,000; Full time

Benefits offered by this job

Competitive benefits

Equal Opportunity Employer

Job summary

Molina Healthcare in California seeks a senior healthcare services leader to oversee utilization management, care management, and related programs. Requires an active California RN/LPN/LCSW/LMFT/LPC/LMSW license with significant IPA delegation experience and the ability to work remotely within the state.

The role directs multidisciplinary teams, collaborates with senior leadership, and drives enterprise-wide care delivery and cost-effective member care strategies.

Qualifications

• Requires RN/LVN/LPN or related licensure per state contract; active in-state license.
• 8+ years healthcare experience with 5+ years in managed care domains.
• 3+ years healthcare management/leadership experience.
• Experience with state, federal and third-party regulations.
• Ability to lead through change and manage conflicts.
• Strong communication and organizational skills.

Responsibilities

• Directs one or more core health services functions (care/utilization management, LTSS, behavioral health).
• Develops and monitors standardized protocols for care coordination and review.
• Promotes interdepartmental integration to enhance clinical services.
• Keeps senior leadership informed of operational needs; presents solutions.
• Facilitates committees and multidisciplinary teams for enterprise-wide programs.
• Ensures monthly auditing with follow-up actions.
• Engages in clinical training activities and outcomes coaching.
• Develops and mentors healthcare services leadership.
• Local travel may be required based on state/contract requirements.

Skills

Leadership

Communication

Problem solving

Organization

Conflict management

Microsoft Office

Education

RN license

Tools

Microsoft Office

Job description

Molina Healthcare in California seeks a senior healthcare services leader to oversee utilization management, care management, and related programs. Requires an active California RN/LPN/LCSW/LMFT/LPC/LMSW license with significant IPA delegation experience and the ability to work remotely within the state.

The role directs multidisciplinary teams, collaborates with senior leadership, and drives enterprise-wide care delivery and cost-effective member care strategies.