Lead, Healthcare Services

Molina Healthcare•Long Beach, CA

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. The role 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 Lead supports department operations by coordinating assignments and processes, resolving day-to-day issues, assisting with staff training, monitoring workloads and compliance, participating in audits, and advising leadership about operational, staffing, system, and program needs. The position maintains a minimal caseload and provides subject-matter expertise, education, and support to clinical and non-clinical staff. It may also collaborate with leadership on daily authorization and care management monitoring tools and serve as a liaison to 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 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.
Qualifying professional credential: 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 required license 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 in 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 simultaneously and adapt 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 and 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

Support healthcare services staff by devising and implementing delegation and assignment strategies, facilitating processes, and coordinating activities.
Resolve issues and complaints arising in day-to-day healthcare services operations and communicate escalation issues to leadership.
Assist in training healthcare services staff according to departmental standards, policies, and procedures.
Maintain a minimal caseload to ensure adherence to guidelines and assist staff whose member caseloads require additional support.
Keep healthcare services leadership apprised of operational issues, staffing issues, system needs, 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 auditing to review and communicate findings and identify opportunities to improve quality and compliance.
Share quality and productivity scores with individual staff members.
Provide leadership with feedback 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 non-compliant 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.