Manager, Healthcare Services (Remote)

Lensa; Grand Island (NE); Remote; USD 77,000 - 172,000; Full time

Job summary

An established industry player in healthcare is seeking a dynamic Manager of Healthcare Services to lead integrated teams in delivering optimal care for members. This role focuses on ensuring compliance with regulations, managing clinical staff, and enhancing care continuity through collaboration. With a commitment to quality and cost-effective solutions, the ideal candidate will have extensive experience in utilization management and a strong background in healthcare operations. If you're passionate about making a difference in the lives of patients and thrive in a collaborative environment, this opportunity is perfect for you.

Qualifications

• 5+ years of managed healthcare experience with 3+ years in utilization management.
• Minimum 2 years of supervisory or managerial experience in healthcare.

Responsibilities

• Manage integrated Healthcare Services teams to ensure optimal care delivery.
• Oversee staff performance, training, and interdepartmental collaboration.

Skills

Utilization Management

Case Management

Healthcare Regulations

Clinical Supervision

Interdepartmental Collaboration

Education

Registered Nurse

Bachelor's or Master's Degree in Nursing or related field

Job description

Molina Healthcare Services (HCS) works with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

This position is seeking someone with experience in utilization management. Please include your experience on your resume.

KNOWLEDGE/SKILLS/ABILITIES

The Manager, Healthcare Services provides operational management and oversight of integrated Healthcare Services (HCS) teams responsible for providing Molina Healthcare members with the right care at the right place at the right time and assisting them to achieve optimal clinical, financial, and quality of life outcomes.

Responsible for clinical teams (including operational teams, where integrated) performing one or more of the following activities: care review/utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), case management, transition of care, health management, and/or member assessment.

Typically, through one or more direct report supervisors, facilitates integrated, proactive HCS management, ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina Clinical Model.

Manages and evaluates team member performance; provides coaching, counseling, employee development, and recognition; ensures ongoing, appropriate staff training; and has responsibility for the selection, orientation, and mentoring of new staff.

Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance the continuity of care including Behavioral Health and Long-Term Services & Supports for Molina members. Oversees Interdisciplinary Care Team meetings.

Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities.

Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.

Collates 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 and 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, while identifying opportunities for improvement.

JOB QUALIFICATIONS

Required Education

Registered Nurse or equivalent combination of Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license.

OR Bachelor's or master’s degree in Nursing, Gerontology, Public Health, Social Work, or related field.

Required Experience

5+ years of managed healthcare experience, including 3 or more years in one or more of the following areas: utilization management, case management, care transition, and/or disease management.

Minimum 2 years of healthcare or health plan supervisory or managerial experience, including oversight of clinical staff.

Experience working within applicable state, federal, and third-party regulations.

Required License, Certification, Association

If licensed, license must be active, unrestricted, and in good standing.

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

Master's Degree preferred.

Preferred Experience

3+ years supervisory/management experience in a managed healthcare environment.

Medicaid/Medicare Population experience with increasing responsibility.

3+ years of clinical nursing experience.

Preferred License, Certification, Association

Any of the following:

• Certified Case Manager (CCM)
• Certified Professional in Healthcare Management Certification (CPHM)
• Certified Professional in Health Care Quality (CPHQ)
• Other healthcare or management certification.

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

Pay Range: $77,969 - $171,058 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.