RN Leader: Managed Care & Care Coordination

Molina Healthcare; San Bernardino (CA); On-site; USD 84,000 - 164,000; Full time

Job summary

Molina Healthcare is seeking an experienced Managed Care Leader in Southern California. The role leads a multidisciplinary team to coordinate care management, utilization management, and transitions while meeting regulatory and contractual obligations.

The successful candidate has at least 7 years in healthcare with 3 years in managed care and 1 year of leadership. Strong collaboration, communication, and organizational skills are essential for delivering high-quality, cost-effective member care.

Qualifications

• At least 7 years of health care experience with 3 years in managed care.
• 1 year of management/leadership experience.
• Clinical licensure/certification required only if state contract mandates.
• Strong customer service and member-centric focus.
• Ability to work in diverse settings and with diverse populations.
• Ability to prioritize multiple deadlines.
• Strong organizational and problem-solving skills.
• Ability to collaborate in a matrixed organization.
• Excellent written and verbal communication; proficient with MS Office.

Responsibilities

• Oversees team performance for care management, utilization management, transitions, behavioral health, LTSS, or special programs.
• Facilitates integrated, proactive healthcare services management while ensuring regulatory compliance.
• Acts as a hands-on leader assessing systems, operations, and efficiency of care delivery.
• Ensures staffing, service levels, and customer satisfaction through productivity metrics.
• Implements program activities in line with regulatory, contract, and accreditation standards.
• Ensures alignment of member care with Molina's customer service standards.
• Monitors high-risk, complex members and supports care delivery continuity.
• Reports on performance, utilization, cost-effectiveness, and program outcomes.
• Collaborates with senior leadership and cross-functional teams on operational needs.
• Leads interdepartmental collaboration to improve continuity of care.
• Oversees ICT meetings and care access metrics; drives continuous improvements.

Skills

Leadership

Collaboration

Operations management

Customer service

Prioritization

Organization

Problem-solving

Communication

MS Office proficiency

Education

RN

LVN

LPN

LCSW

LMFT

LPCC

LMSW

Tools

Microsoft Office

Job description

Molina Healthcare is seeking an experienced Managed Care Leader in Southern California. The role leads a multidisciplinary team to coordinate care management, utilization management, and transitions while meeting regulatory and contractual obligations.

The successful candidate has at least 7 years in healthcare with 3 years in managed care and 1 year of leadership. Strong collaboration, communication, and organizational skills are essential for delivering high-quality, cost-effective member care.