Supervisor, Healthcare Services

Molina Healthcare; United States; On-site; USD 90,000 - 120,000; Full time

Job summary

Molina Healthcare is seeking a RN/LPN/LVN-certified healthcare services leader to supervise a multidisciplinary team across care management, utilization management, and LTSS. You will ensure integrated, cost-effective member care and drive quality outcomes across the continuum.

The role requires strong leadership, regulatory acumen, and the ability to collaborate with senior healthcare leadership to optimize performance and member satisfaction.

Qualifications

• Active RN, LVN, or LPN license in state of practice.
• 5+ years of healthcare experience including managed care components (utilization/care management).
• Strong customer service orientation and excellent communication skills.

Responsibilities

• Oversees team performance in care management, utilization management, transitions of care, behavioral health, LTSS, or special programs.
• Facilitates integrated, proactive services while ensuring regulatory and accreditation compliance.
• Functions as a hands-on leader supporting assessment and evaluation of systems and day-to-day operations.
• Analyzes care access, plan utilization, staff productivity and outcomes to drive cost-effective care.

Skills

Customer service

Written and verbal communication

Cross-functional collaboration

Microsoft Office proficiency

Education

RN license

LVN license

LPN license

Tools

Microsoft Office

Job description

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.

PST Hours

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), and Licensed Practical Nurse (LPN). 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. Moli