Lead, Healthcare Services

Molina Healthcare • Miami, FL

2d • $29 - $57

About The Position

Provides lead-level clinical support to the healthcare services team in one or more areas, 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 quality, cost-effective care. The role helps facilitate department operations, support and educate staff, monitor workload and compliance, participate in auditing and quality improvement, and serve as a liaison for internal and external customers. Local travel may be required based on state or contractual requirements.

Requirements

• At least 4 years of healthcare experience, 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.
• Hold one of the following credentials: 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.
• Be proactive and detail-oriented.
• Ability to work in varied settings and adjust work style when interacting with diverse populations, personalities, and personal situations.
• Ability to work independently with minimal supervision and demonstrate self-motivation.
• Responsiveness across all forms of communication.
• 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 focus on multiple projects and adapt to change.
• Excellent problem-solving and critical-thinking skills.
• Strong verbal and written communication skills.
• Proficiency with Microsoft Office Suite and applicable software programs.

Nice To Haves

• Active, unrestricted Registered Nurse (RN) 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.
• Experience with Medicaid or Medicare populations.
• Clinical experience.

Responsibilities

• Provide lead-level support to healthcare services staff by devising and implementing delegation assignment strategies, facilitating processes, and coordinating activities.
• Resolve day-to-day operational issues and complaints, and communicate escalation issues to healthcare services leadership.
• Assist with staff training in accordance with department standards, policies, and procedures.
• Maintain a minimal caseload to support guideline adherence and assist staff with member caseloads requiring additional support.
• Keep healthcare services leadership informed of operational and staffing issues, system needs, 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 opportunities to improve quality and compliance.
• Share quality and productivity scores with individual staff members.
• Provide leadership with feedback on staff performance and consult on corrective action as needed for performance improvement.
• May collaborate with leadership to ensure the daily authorization reconciliation report (DARR) is run each work day and non-compliant or incomplete cases are promptly remediated.
• May collaborate with leadership to ensure the care management monitoring tool (CMMT) is run each work day and cases are addressed to maintain health risk assessment (HRA) and care plan compliance.
• Serve 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 or participate in departmental, company-wide, and external committees, task forces, or work groups as assigned.
• Travel locally as required by state or contractual requirements.

Benefits

• Competitive benefits and compensation package.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed