VP, Healthcare Services (Nevada)

Molina Healthcare; Reno (NV); On-site; USD 162,000 - 316,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare, Inc. is seeking an executive leader to drive strategy and coordination across care management, utilization management, behavioral health, LTSS, and related programs.

You will align clinical and business objectives, lead multidisciplinary teams, and ensure high-quality, cost-effective member care. The role requires extensive managed care experience, strong leadership, and the ability to navigate complex regulatory landscapes while delivering superior outcomes and value for

Qualifications

• 12+ years in healthcare with 10+ years in managed care roles
• 7+ years of management/leadership experience
• Active licensure if required by state contract/regulation
• Experience with applicable state/federal regulations
• Strong customer service and member-centric focus
• Data analysis and critical thinking
• Ability to manage multiple deadlines
• Strong organizational and problem-solving skills
• Collaborate cross-functionally in a matrixed org
• Lead through change and drive process improvements
• Excellent written and verbal communication
• Proficiency in Microsoft Office

Responsibilities

• Provide executive strategy and leadership for healthcare services teams
• Set strategic clinical, quality, and financial measures
• Ensure regulatory compliance and integration of the Molina clinical model
• Oversee a fully integrated service model across care management, LTSS, and behavioral health
• Develop and monitor standardized care coordination protocols
• Ensure staffing levels and monitor staff productivity and KPIs
• Collaborate with CMO and medical director to manage clinical policies
• Develop initiatives to reduce medical expenses while improving quality
• Oversee program implementation and performance monitoring
• Represent Molina in external meetings with regulators and partners
• Promote interdisciplinary collaboration and continuous improvement

Skills

Leadership

Data analysis

Communication

Customer service

Problem solving

Cross-functional collaboration

Education

RN/LCSW/LMFT/LPCC/LMSW etc.

Tools

Microsoft Office

Job description

JOB DESCRIPTION Job Summary

Provides executive level strategy and leadership to a team of multidisciplinary 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. Partners with executive leadership to ensure alignment with business goals. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Supports executive health plan or enterprise strategy development, vision and direction for one or more of the following key healthcare services (HCS) functions: care management, utilization management, care transitions, behavioral health, long-term services and supports (LTSS), and/or special programs. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
• Determines strategic clinical, quality, financial measures for success.
• Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model.
• Provides oversight to ensure state plan implementation of a fully integrated service model wherein health service needs are managed together with medical care needs in order to meet the whole health needs of members and promote improved outcomes with lowered costs.
• Facilitates integration of care coordination, care transitions, long-term care, behavioral health, chemical dependency and other special programs.
• Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination/care review and management.
• Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
• Collaborates with the chief medical officer (CMO) and medical director team to develop and implement processes to effectively manage clinical policies to meet health care cost and quality targets.
• Develops initiatives to achieve budgeted reductions in medical expenses and increases in quality scores.
• Oversees implementation of 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.
• Oversees ongoing monitoring of performance, protocols and guidelines related to healthcare services.
• Keeps senior level leadership apprised of operational issues, staffing, resources, system and program needs, and presents solutions/action plans for remediation.
• Promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care; demonstrates ultimate oversight for interdisciplinary care team (ICT) meetings.
• 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.
• Continually refines operational processes and champions review of team processes, workflows and activities.
• Ensures compliance with all contractual obligations- meeting or exceeding standards.
• Manages implementation of analytical studies that quantify the benefits of healthcare services programs to ensure that resources are appropriately allocated, operational controls exist, and efficiencies are maximized.
• 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.
• Provides oversight in the successful implementation of healthcare services for new business/expansions.
• Identifies and reviews new products to enhance care service delivery, safety net planning, development of alternative levels of care (with anticipated improved outcomes with cost offsets), predictive modeling, integration with medical care management, or other approaches that support the patient centered medical home.
• Articulates project requirements and anticipated outcomes to the Molina project management office for identified projects/strategies to improve the efficiency of clinical operations teams to meet cost and quality goals.
• Develops health care services department budget and ensures budget targets are met.
• Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs.
• Attends local, state or national conferences as indicated to maintain current knowledge of behavioral health service best practices, service delivery models, state initiatives, etc.
• Represents Molina in external meetings regarding healthcare services management with state regulators, provider groups, community service agencies, advocacy groups or other stakeholders.
• Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate.
• Hires, trains, develops and manages team demonstrates accountability for team performance and achievement of department-specific goals.
• Develops and sustains a high-performance team, dedicated to best-in-class solutions responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives.
• Local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 12 years of health care experience, including at least 10 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.
• At least 7 years of management/leadership 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.
• Experience working within applicable state, federal, and third-party regulations
• 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.
• Data analysis and critical-thinking skills.
• Ability to prioritize and manage multiple deadlines.
• Strong organizational and problem-solving skills.
• Operational and process improvement experience.
• Ability to collaborate cross-functionally within a highly matrixed organization.
• Ability to manage conflict and lead through change.
• Excellent written and verbal communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.

Preferred Qualifications

• 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: $161,914.25 - $315,733 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.