Director of Inpatient Utilization & Care Management

Jobtome; San Jose (CA); Hybrid; USD 102,000 - 198,000; Full time

Job summary

Molina Healthcare is seeking a senior healthcare services leader in California who will direct and coordinate care management, utilization management and related programs. The role requires active California licensure and substantial IPA delegation experience, with the ability to guide cross-functional teams and ensure compliant, cost-effective member care.

The position emphasizes leadership, strategic planning, and collaboration with senior leadership to drive standardized processes across the

Qualifications

• 8+ years health care experience with 5+ years in managed care.
• 3+ years health care management/leadership.
• Active CA RN/LPN/LCSW/LMSW/LMFT/LPCC license where required by contract.
• Experience with applicable state/federal regulations.
• Ability to manage conflict and lead through change.
• Strong written and verbal communication skills.
• Proficiency in MS Office or equivalent software.

Responsibilities

• Direct and oversee care management, utilization management, care transitions, LTSS, behavioral health or related programs.
• Develop and monitor standardized protocols for clinical and non-clinical activities to coordinate care.
• Promote interdepartmental integration to enhance clinical services.
• Keep senior leadership informed of issues and present solutions/action plans.
• Facilitate committees and multidisciplinary teams to promote enterprise-wide standards.
• Ensure monthly auditing with appropriate follow-up.
• Engage in clinical training activities and mentor leadership.
• Local travel may be required.

Skills

Leadership

Communication

Conflict resolution

Regulatory compliance

Microsoft Office

Education

RN license (CA)

Licensed clinical licensure considered where required

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a senior healthcare services leader in California who will direct and coordinate care management, utilization management and related programs. The role requires active California licensure and substantial IPA delegation experience, with the ability to guide cross-functional teams and ensure compliant, cost-effective member care.

The position emphasizes leadership, strategic planning, and collaboration with senior leadership to drive standardized processes across the