Lead, Healthcare Services

Molina Healthcare•Long Beach, WA

About The Position

Provides lead-level clinical support to the healthcare services team across one or more functions, including care management, utilization management, care transitions, long-term services and supports (LTSS), behavioral health, and other clinical programs. Collaborates with a multidisciplinary team to coordinate integrated member care across the continuum, support progress toward desired outcomes, and contribute to the delivery of quality, cost-effective care. The role supports department operations, staff development, quality and compliance, and communication with internal and external customers. Local travel may be required based on state or contractual requirements.

Requirements

At least 4 years of experience in health care, including at least 2 years of managed care experience in utilization management, care management, care transitions, behavioral health, LTSS, or an equivalent combination of relevant education and experience.
A credential as an RN, LVN, LPN, LCSW, LMFT, LPCC, or LMSW. Clinical licensure or certification is required only when mandated by state contract, regulation, business operating model, or state board licensing requirements. Any license held must be active and unrestricted in the state of practice.
Demonstrated knowledge of community resources.
Proactive and detail-oriented approach.
Ability to work in varied settings and adjust style when working with diverse populations, personalities, and personal situations.
Ability to work independently with minimal supervision and demonstrate self-motivation.
Responsiveness across communication channels.
Ability to remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Excellent time-management and prioritization skills, including the ability to manage multiple projects and adapt to change.
Excellent problem-solving and critical-thinking skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office and applicable software programs.

Nice To Haves

Registered Nurse (RN) credential with an active, unrestricted license in the state of practice.
Certified Case Manager (CCM), Certified Professional in Health Care Management (CPHM), Certified Professional in Health Care Quality (CPHQ), or another health care or management certification.
Experience with Medicaid or Medicare populations.
Clinical experience.

Responsibilities

Provide support to healthcare services department staff by devising and implementing delegation and assignment strategies, facilitating processes, and coordinating activities.
Resolve day-to-day healthcare services operational issues and complaints, escalating issues to healthcare services leadership as appropriate.
Assist with training healthcare services staff in accordance with department standards, policies, and procedures.
Maintain a minimal caseload to ensure adherence to guidelines and provide additional support to staff with ongoing member caseloads when needed.
Collaborate with healthcare services leadership and keep them informed of operational and staffing issues, as well as system and program needs.
Serve as a clinical subject matter expert, providing support, recommendations, and education to clinical and non-clinical staff as appropriate.
Monitor staff workload for adherence to policies, procedures, guidelines, and program-specific requirements.
Participate in department audits, communicate findings, and identify opportunities to improve quality and compliance.
Share quality and productivity scores with individual staff members.
Provide leadership with feedback on staff performance issues and consult on corrective action when needed to improve performance.
May collaborate with leadership to ensure the daily authorization reconciliation report (DARR) is run each work day and that non-compliant cases or cases missing compliance elements are promptly remediated.
May collaborate with leadership to ensure the care management monitoring tool (CMMT) is run every work day and cases are addressed to maintain health risk assessment (HRA) and care plan compliance.
Act as a liaison to internal and external customers on behalf of Molina and healthcare services department areas.
Maintain confidentiality and effective workplace relationships, and adhere to the company code of conduct.
Attend or participate in departmental, company-wide, and external committees, task forces, or work groups as assigned.
Travel locally when required by state or contractual requirements.