Manager, Healthcare Services

Job Summary

Leads and manages 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.

• 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).

• At least 7 years of health care experience, including at least 3 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 1 year 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…