Director, Inpatient Utilization & Care Management

Jobtome; San Diego (CA); Remote; USD 102,000 - 198,000; Full time

Job summary

Molina Healthcare is seeking an experienced healthcare leader in California to direct multidisciplinary teams across utilization and care management, with a focus on integrated delivery of care and cost-effective member outcomes.

The role requires California RN or equivalent licensure, extensive managed care experience, and the ability to work remotely within the state. Strong leadership and regulatory knowledge are essential for success.

Qualifications

• At least 8 years health care experience, with 5+ years in managed care.
• At least 3 years health care management/leadership.
• RN/LVN/LPN/LCSW/LMFT/LPCC/LMSW licensure active and unrestricted if required by state contract.
• Experience working within applicable state, federal, and third party regulations.
• Ability to manage conflict and lead through change.
• Operational and process improvement experience.
• Strong written and verbal communication skills.
• Microsoft Office suite proficiency.

Responsibilities

• Directs and oversees care management, utilization management, LTSS, behavioral health, and related programs.
• Develops, implements and monitors standardized protocols for clinical and non-clinical team activities.
• Promotes interdepartmental integration and collaboration to enhance clinical services.
• Collaborates with senior leadership and presents solutions/action plans for issues.
• Facilitates committees, task forces and multidisciplinary teams to standardize enterprise-wide programs.
• Ensures monthly auditing with appropriate follow-up.
• Engages in clinical training activities and outcomes.
• Develops and mentors reporting healthcare services leadership.
• Local travel may be required (based upon state/contractual requirements).

Skills

Healthcare leadership

Conflict management

Communication skills

Organizational skills

Time management

Care coordination

Problem solving

Tools

MS Office

Job description

Molina Healthcare is seeking an experienced healthcare leader in California to direct multidisciplinary teams across utilization and care management, with a focus on integrated delivery of care and cost-effective member outcomes.

The role requires California RN or equivalent licensure, extensive managed care experience, and the ability to work remotely within the state. Strong leadership and regulatory knowledge are essential for success.