Lead, Healthcare Services

Molina Healthcare•FL, FL

2d•$29 - $57

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 and cost-effective care. The role supports staff and operational processes, maintains a minimal member caseload, monitors quality and compliance, and serves as a 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 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.
Qualify 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 requirements; 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 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.
Responsive 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, with 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 suite 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.
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, escalating issues to healthcare services leadership as needed.
Assist with training healthcare services staff according to department standards, policies, and procedures.
Maintain a minimal caseload and assist staff with member caseloads requiring additional support.
Keep healthcare services leadership apprised of operational, staffing, system, and program needs.
Provide clinical guidance, recommendations, and education to clinical and non-clinical staff as a subject matter expert.
Monitor staff workloads for adherence to policies, procedures, guidelines, and program requirements.
Participate in the department auditing program, review and communicate findings, and identify quality and compliance improvements.
Share quality and productivity scores with individual staff.
Provide leadership with feedback on staff performance and consult on corrective action when needed.
May collaborate with leadership to ensure the daily authorization reconciliation report (DARR) is run each workday and non-compliant or incomplete cases are remediated promptly.
May collaborate with leadership to ensure the care management monitoring tool (CMMT) is run each workday 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 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 when required by state or contractual requirements.