Lead, Healthcare Services

Molina Healthcare•Long Beach, FL

About The Position

Provides lead-level clinical support to the healthcare services team across 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, support progress toward desired outcomes, and contribute to quality, cost-effective care. The role supports healthcare services staff and operations by coordinating assignments and processes, addressing operational issues, assisting with staff training, monitoring workload and compliance, participating in audits, and sharing quality and productivity information. It maintains a minimal member caseload and serves as a clinical subject matter expert and liaison for 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.
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: 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 Social Worker (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.
Be proactive and detail-oriented.
Ability to work in varied settings and adjust approach when working 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 manage multiple projects simultaneously, and adaptability 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

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 lead-level support to healthcare services staff, including devising and implementing delegation and assignment strategies, facilitating processes, and coordinating activities.
Resolve day-to-day healthcare services operational issues and complaints and communicate escalations to healthcare services leadership.
Assist with training healthcare services staff according to department standards, policies, and procedures.
Maintain a minimal caseload to support adherence to applicable guidelines and assist staff with ongoing member caseloads when additional support is needed.
Collaborate with healthcare services leadership and keep them informed about operational, staffing, system, 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.
Provide feedback to leadership about staff performance issues and consult on corrective action for performance improvement.
May collaborate with leadership to ensure the daily authorization reconciliation report is run each work day and noncompliant or incomplete cases are promptly remediated.
May collaborate with leadership to ensure the care management monitoring tool is run every 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 department areas.
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 when required by state or contractual requirements.