Lead, Healthcare Services

Molina Healthcare•Portland, OR

5d•$29 - $65

About The Position

Provides lead-level clinical support to the healthcare services team across one or more functions, 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.

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.
Must hold one of the following credentials: 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.
Able to work in varied settings and adjust approach when working with diverse populations, personalities, and personal situations.
Able to work independently with minimal supervision and demonstrate self-motivation.
Responsive across all forms of communication.
Able to remain calm in high-pressure situations.
Able to develop and maintain professional relationships.
Excellent time-management and prioritization skills, including 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

Provides support to healthcare services staff by devising and implementing delegation assignment strategies, facilitating department processes, and communicating and coordinating activities.
Resolves day-to-day operational issues and complaints and communicates escalations to healthcare services leadership.
Assists with training staff in accordance with department standards, policies, and procedures.
Maintains a minimal caseload and provides support to staff managing member caseloads when additional assistance is needed.
Keeps healthcare services leadership informed about operational and staffing issues and system and program needs.
Acts as a clinical subject matter expert, providing support, recommendations, and education to clinical and non-clinical staff.
Monitors staff workloads for adherence to policies, procedures, guidelines, and program-specific requirements.
Participates in department audits, communicates findings, and identifies quality and compliance improvement opportunities.
Shares quality and productivity scores with individual staff members.
Provides leadership with feedback on staff performance and consults on corrective action for performance improvement.
May collaborate with leadership to ensure the daily authorization reconciliation report (DARR) is run each work day and that noncompliant 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.
Liaises with internal and external customers on behalf of Molina and healthcare services department areas.
Maintains confidentiality, effective workplace relationships, and compliance with the company code of conduct.
Attends or participates in departmental, company-wide, and external committees, task forces, or work groups as assigned.
May travel locally based on state or contractual requirements.