Lead, Healthcare Services

Molina Healthcare•Long Beach, MA

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 quality, cost-effective care.

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.
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 required license 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 adapt style 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, with 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) 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 healthcare or management certification.
Experience with Medicaid or Medicare populations.
Clinical experience.

Responsibilities

Support healthcare services staff by devising and implementing delegation and 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 training staff in accordance with department standards, policies, and procedures.
Maintain a minimal caseload to support guideline adherence and assist staff with ongoing member caseloads when additional support is needed.
Collaborate with healthcare services leadership and keep them informed of operational, staffing, system, and program needs.
Provide subject-matter expertise, recommendations, and education to clinical and non-clinical staff.
Monitor staff workloads 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 as needed.
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 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 departments.
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.