Remote CA Director of Inpatient Utilization

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

Job summary

Molina Healthcare in California seeks a seasoned healthcare services leader to oversee care management, utilization management, and related programs. This role requires an active California RN license and significant IPA delegation experience, with opportunity for remote work within the state.

The incumbent will guide a multidisciplinary team, drive standardized protocols, align with senior leadership, and ensure compliant, high-quality, cost-effective member care across the delivery continuum.

Qualifications

• At least 8 years health care experience with at least 5 years in managed care.
• At least 3 years health care management/leadership experience.
• Active and unrestricted clinical licensure if required by state contract or regulation.
• Experience with state, federal and third-party regulations.
• Ability to lead through change and manage conflict.
• Operational and process improvement experience.
• Strong written and verbal communication skills.
• Proficiency with Microsoft Office suite.

Responsibilities

• Directs and oversees care management, utilization management, care transitions, LTSS, behavioral health, or related programs.
• Develops and monitors standardized protocols for clinical and non-clinical activities.
• Promotes interdepartmental collaboration to enhance clinical services.
• Keeps senior leadership informed of issues and presents solutions.
• Participates in committees and cross-functional teams to standardize enterprise-wide approaches.
• Ensures monthly auditing with follow-up and implements corrective actions.
• Engages in clinical training and mentorship of reporting leaders.
• Travel may be required based on state/contractual requirements.

Skills

Healthcare leadership

Managed care experience

Conflict management

Cross-functional collaboration

Communication skills

Problem solving

MS Office

Education

RN/LVN/LPN/LCSW/LMFT/LPCC/LMSW license (active, unrestricted)

Tools

Microsoft Office

Job description

Molina Healthcare in California seeks a seasoned healthcare services leader to oversee care management, utilization management, and related programs. This role requires an active California RN license and significant IPA delegation experience, with opportunity for remote work within the state.

The incumbent will guide a multidisciplinary team, drive standardized protocols, align with senior leadership, and ensure compliant, high-quality, cost-effective member care across the delivery continuum.