Manager, Healthcare Services

Molina Talent Acquisition; United States; On-site; USD 120,000 - 170,000; Full time

Job summary

Molina Healthcare is seeking a senior healthcare services leader to manage a multidisciplinary team focused on care management, utilization management, behavioral health, LTSS, and related programs in the United States. You will drive integrated care delivery, ensure regulatory compliance, and lead strategic improvements to meet quality and cost objectives.

In this role, you will oversee staffing, performance, and program activities, collaborate with senior leadership, and champion

Qualifications

• 7+ years in health care with managed care experience in care management, utilization management, LTSS, or related areas
• 1+ year of management/leadership experience
• Active licensure where required by state contract/regulation/operating model
• Strong customer service orientation and patient/member focus
• Ability to collaborate in a highly matrixed organization
• Proficiency with Microsoft Office and healthcare software

Responsibilities

• Oversees team performance for care management, utilization management, LTSS, and/or special programs.
• Facilitates integrated, proactive healthcare services management with regulatory and accreditation compliance.
• Acts as a hands-on leader, assessing and improving day-to-day operations and care delivery.
• Ensures staffing and service levels meet demand and monitors productivity and performance metrics.
• Implements care management activities in line with regulatory and contract standards.
• Ensures services align with Molina's customer service standards and drives high-quality care.
• Monitors high-risk, complex members and maintains effective program support.
• Collaborates with senior leadership to address operational issues, resources, and system needs.
• Promotes interdepartmental integration to enhance continuity of care and leads ICT meetings.
• Analyzes care access and utilization statistics to guide improvements and reporting.
• Conducts staff quality audits and recommends enhancements for efficiency and compliance.
• Maintains relationships with providers, customers, and state agencies; identifies care delivery improvements.
• Leads recruitment, training, and development of the team with accountability for goals.
• Travel may be required based on state/contract requirements.

Skills

People management

Communication skills

Strategic planning

Problem solving

Microsoft Office

Education

RN or LCSW/LMFT/LPCC/LMSW licensure (state-specific)

Tools

Microsoft Office Suite

Job description

JOB DESCRIPTION Job Summary

Leads and manages a multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Oversees team performance for one or more of the following healthcare services functions: care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition of care, behavioral health, long-term services and supports (LTSS), and/or special programs.
• Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model.
• Functions as a "hands-on" leader - assisting with assessing and evaluation of systems, day-to-day operations and efficiency of services/care delivery.
• Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
• Assists in implementing care management, utilization management, behavioral health, care transitions, LTSS and other program activities in accordance with regulatory, contract standards and accreditation compliance.
• Ensures delivery of member care and services are aligned with Molina's established standards of customer service excellence.
• Ensures high-risk, complex members are adequately supported.
• Oversees ongoing monitoring of performance, protocols and guidelines related to healthcare services.
• Collaborates with and keeps senior level healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
• Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care.
• Oversees interdisciplinary care team (ICT) meetings.
• Analyzes and reports on care access and monitoring statistics including plan utilization, staff productivity, cost-effective utilization of services, management of targeted member population, and triage activities.
• Ensures completion of staff quality audit reviews evaluates services provided, outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost-effectiveness and compliance with all state and federal regulations and guidelines.
• Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate.
• Identifies opportunities for care delivery/quality/operational/etc. process improvements.
• Hires, trains, develops and manages team demonstrates accountability for team performance and achievement of department-specific goals.
• Local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 7 years of health care experience, including at least 3 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or special programs, or equivalent combination of relevant education and experience, or equivalent combination of relevant education and experience.
• At least 1 year of management/leadership experience.
• Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). 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 customer service skills/member-centric focus.
• Ability to work within a variety of settings and adjust style as needed, including ability to work with diverse populations, various personalities and personal situations.
• Ability to prioritize and manage multiple deadlines.
• Strong organizational and problem-solving skills.
• Ability to collaborate cross-functionally within a highly matrixed organization.
• Strong written and verbal communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.

Preferred Qualifications

• Clinical experience.
• Registered Nurse (RN) or master's level behavioral health (BH) licensure. License must be active and unrestricted in state of practice.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
• Medicaid/Medicare population experience.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V