Supervisor, Healthcare Services

Jobtome; Jacksonville (FL); Vor Ort; USD 66.000 - 130.000; Vollzeit

Zusammenfassung

Molina Healthcare in Jacksonville, FL seeks an experienced Healthcare Services Team Leader to supervise a multidisciplinary group across care management, utilization review, and LTSS. You will ensure integrated delivery, regulatory compliance, and high-quality member care.

The role emphasizes hands-on leadership, staff development, and collaboration with senior leadership to meet program goals. Strong RN/LPN/LCSW/LMFT/LPCC credentials may be preferred. Local travel may be required.

Qualifikationen

• Minimum 5 years of health care experience with at least 2 years in managed care.
• Clinical licensure and/or certification required if mandated by state contract, regulation, or licensing mandates; license must be active and unrestricted.
• Strong customer service and member-centric focus.
• Ability to work across diverse settings and populations and to collaborate in a matrixed organization.
• Excellent written and verbal communication; proficient in Microsoft Office and related software.

Aufgaben

• Oversees team performance for care management, utilization management, transition of care, behavioral health, LTSS, or related programs.
• Facilitates proactive healthcare services management and ensures compliance with regulatory and accreditation standards.
• Acts as a hands-on leader, assessing systems, day-to-day operations, and efficiency of care delivery.
• Ensures staffing levels and productivity meet service level targets and customer satisfaction.
• Drives program activities in line with contractual and regulatory requirements; promotes interdepartmental collaboration.
• Monitors performance metrics and reports on access, utilization, and cost-effectiveness.
• Maintains relationships with providers, customers, and state agencies; identifies opportunities for improvements.
• Hires, trains, and develops team members and travels as required by contract.

Kenntnisse

Customer service

Communication skills

Organizational skills

Problem-solving

Collaboration

Multitasking

Ausbildung

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

Tools

Microsoft Office

Jobbeschreibung

JOB DESCRIPTION Job Summary

Leads and supervises a 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 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.

Essential Job Duties

• Oversees team performance for one or more of the following healthcare services functions: care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition of care, behavioral health, long-term services and supports (LTSS), and/or special programs.
• Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model.
• Functions as a "hands-on" leader - assisting with assessing and evaluation of systems, day-to-day operations and efficiency of services/care delivery.
• Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
• Assists in implementing care management, utilization management, behavioral health, care transitions, LTSS and other program activities in accordance with regulatory, contract standards and accreditation compliance.
• Ensures delivery of member care and services are aligned with Molina's established standards of customer service excellence.
• Ensures high-risk, complex members are adequately supported.
• Oversees ongoing monitoring of performance, protocols and guidelines related to healthcare services.
• Collaborates with and keeps senior level healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
• Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care.
• Oversees interdisciplinary care team (ICT) meetings.
• Analyzes 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, 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.
• Identifies opportunities for care delivery/quality/operational/etc. process improvements.
• Hires, trains, develops and manages team demonstrates accountability for team performance and achievement of department-specific goals.
• Local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 5 years of health care experience, including at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or special programs, or equivalent combination of relevant education and experience, or equivalent combination of relevant education and 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, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
• Strong customer service skills/member-centric focus.
• Ability to work within a variety of settings and adjust style as needed, including ability to work with diverse populations, various personalities and personal situations.
• Ability to prioritize and manage multiple deadlines.
• Strong organizational and problem-solving skills.
• Ability to collaborate cross-functionally within a highly matrixed organization.
• Strong written and verbal communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.

Preferred Qualifications

• Management/leadership experience.
• Clinical experience.
• Registered Nurse (RN) or master's level behavioral health (BH) licensure. 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.

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

Pay Range: $66,456 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.