Lead, Healthcare Services

Molina Healthcare•Waltham, MA

4d•$33 - $65

About The Position

Provides lead-level clinical support to the healthcare services team, supporting one or more functions such as 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, promote progress toward desired outcomes, and contribute to the strategy of delivering quality, cost-effective care. The role supports healthcare services staff and operations through delegation strategies, process coordination, issue resolution, staff training, workload monitoring, auditing, and performance feedback. It maintains a minimal member caseload and provides clinical expertise, recommendations, and education to clinical and non-clinical staff. The position also liaises with internal and external customers and may require local travel based on state or contractual requirements.

Requirements

At least 4 years of healthcare experience and 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 required by state contract, regulation, business operating model, or state board licensing mandates; any license held must be active and unrestricted in the state of practice.
Demonstrated knowledge of community resources.
Proactive and detail-oriented.
Ability to work in a variety of settings and adapt working style when engaging with diverse populations, personalities, and personal situations.
Ability to work independently with minimal supervision and demonstrate self-motivation.
Responsiveness across forms of communication.
Ability to remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Excellent time-management and prioritization skills, ability to focus on multiple projects simultaneously, and adaptability 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) 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 healthcare or management certification.
Medicaid or Medicare population experience.
Clinical experience.

Responsibilities

Support healthcare services staff by devising and implementing delegation assignment strategies, facilitating processes, and coordinating activities.
Resolve issues and complaints arising in day-to-day operations and communicate escalations to healthcare services leadership.
Assist in training healthcare services staff according to department standards, policies, and procedures.
Maintain a minimal caseload and assist staff with ongoing member caseloads requiring additional support.
Keep healthcare services leadership apprised of operational issues, staffing issues, systems, and program needs.
Provide subject-matter expertise, recommendations, and education to clinical and non-clinical staff.
Monitor staff workload for adherence to policies, procedures, guidelines, and program-specific requirements.
Participate in department audits, communicate findings, and identify quality and compliance improvement opportunities.
Share quality and productivity scores with individual staff.
Provide leadership with feedback on staff performance issues and consult on corrective action as needed.
May help ensure the daily authorization reconciliation report is run each work day and non-compliant or incomplete cases are promptly remediated.
May help ensure the care management monitoring tool is run each work day and cases are addressed to maintain health risk assessment and care plan compliance.
Act as a liaison to internal and external customers on behalf of Molina and healthcare services departments.
Maintain confidentiality, effective workplace relationships, and adherence to the company code of conduct.
Attend and participate in departmental, company-wide, and external committees, task forces, or work groups as assigned.
Travel locally when required by state or contractual requirements.