Senior Clinical Services Lead: Care Management & Transitions

Jobtome

Orlando (FL)

On-site

USD 40,000 - 78,000

Full time

6 days ago

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Job summary

Molina Healthcare is seeking a lead-level clinical support professional to bolster the healthcare services team across care management, utilization management, LTSS, behavioral health, and related programs. You will collaborate with a multidisciplinary team to coordinate member care and drive progress toward outcomes while aligning with quality and cost objectives.

In this role you will guide staff in processes, train according to policies, monitor workloads, and escalate issues to leadership.

Qualifications

At least 4 years in health care with 2 years in managed care (utilization/care management, LTSS, behavioral health) or equivalent.
License as RN/LVN/LPN/LCSW/LMFT/LPCC/LMSW must be active and unrestricted where state contract requires it.
Demonstrated knowledge of community resources.
Proactive, detail-oriented, and able to work independently with minimal supervision.
Excellent verbal and written communication skills.
Strong problem-solving and critical-thinking abilities.
Ability to manage multiple priorities and adapt to change.
Proficient with Microsoft Office apps.

Responsibilities

Provides lead level clinical support to the healthcare services team across care management, utilization management, LTSS, behavioral health and related programs.
Resolves issues and escalates to leadership when needed, ensuring timely communication.
Assists in training healthcare services staff according to department policies and procedures.
Maintains a minimal caseload while guiding staff with ongoing caseload requirements.
Collaborates with leadership and informs them of operational issues and staffing needs.
Acts as a subject matter expert to support clinical and non-clinical staff and improves processes.
Monitors staff workload for policy compliance and productivity.
Participates in auditing to identify quality and compliance opportunities.
Shares performance feedback with leadership and assists with corrective actions as needed.
May coordinate daily authorization reconciliation and CMMT monitoring to maintain HRA and care plan compliance.
Acts as liaison to internal and external customers for Molina Healthcare and the healthcare services department.
Maintains confidentiality and upholds the code of conduct; participates in committees and work groups as assigned.
Local travel may be required based on state/contract requirements.