Manager, Healthcare Services; Behavioral Health (Remote GA)

Molina Healthcare; Alpharetta (GA); Remote; USD 73,000 - 143,000; Full time

Job summary

A leading healthcare organization is seeking a Manager for a multidisciplinary team. The position offers flexibility for remote work but requires residence in Georgia. The role involves managing care reviews and ensuring quality member outcomes through coordinated care. Ideal candidates will have extensive healthcare management experience and active clinical licensure. A competitive salary package is offered.

Benefits

Competitive benefits and compensation package

Equal Opportunity Employer status

Qualifications

• 7+ years of experience in healthcare, with 3+ years in managed care.
• 1+ years of health care management/leadership experience required.
• Active clinical licensure required as per state regulations.

Responsibilities

• Lead and manage care management and utilization management activities.
• Promote continuity of care through integrated healthcare services.
• Evaluate team performance and conduct training and staff development.

Skills

Proactive and detail-oriented

Excellent problem-solving and critical-thinking skills

Excellent verbal and written communication skills

Time-management and prioritization skills

Education

Registered Nurse (RN)

Licensed Vocational Nurse (LVN)

Licensed Practical Nurse (LPN)

Licensed Clinical Social Worker (LCSW)

Tools

Microsoft Office

Job description

Overview

This position will offer remote work flexibility, however, the selected candidate must reside in the state of Georgia.

JOB DESCRIPTION Job Summary

Leads and manages 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 other 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.

Responsibilities

• Lead and manage performance of one or more of the following activities: care review, care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition of care, health management, behavioral health, LTSS, and/or member assessment.
• Facilitate integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model.
• Manage and evaluate team member performance, provide coaching, employee development and recognition, ensure ongoing staff training, and oversee selection, orientation and mentoring of new staff.
• Promote interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care.
• Oversee interdisciplinary care team (ICT) meetings.
• Function as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities.
• Ensure adequate staffing and service levels and maintain customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
• Collate and report on care access and monitoring statistics including plan utilization, staff productivity, cost-effective utilization of services, management of targeted member population, and triage activities.
• Ensure completion of staff quality audit reviews; evaluate services provided, outcomes achieved and recommend enhancements/improvements for programs and staff development to ensure consistent cost-effectiveness and compliance with all state and federal regulations and guidelines.
• Maintain professional relationships with provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement.
• Local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 7 years experience in health care, and at least 3 years of managed care experience in one or more of the following areas: utilization management, care management, care transitions, behavioral health, LTSS, or equivalent combination of relevant education and experience.
• At least 1 year of health care 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 or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
• Experience working within applicable state, federal, and third party regulations.
• Demonstrated knowledge of community resources.
• Proactive and detail-oriented.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving and critical-thinking skills.
• Excellent verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

• Registered Nurse (RN). 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.
• Clinical experience.
• 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

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Pay Range: $73,102 - $142,549 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.