Manager, Healthcare Services (Milwaukee County, WI)

Molina Healthcare•Long Beach, WI

23h

About The Position

Leads and manages a multidisciplinary team of healthcare services professionals in one or more areas, including care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and special programs. Ensures members reach desired outcomes through integrated care coordination across the continuum and contributes to strategy for delivering quality, cost-effective member care. The role oversees team performance, daily operations, staffing, service levels, quality, and compliance with applicable state and federal requirements, contracts, and accreditation standards. It works across departments and with providers, customers, and state agencies to improve continuity of care and service delivery. Local travel may be required based on state or contractual requirements.

Requirements

At least 7 years of healthcare experience, including at least 3 years of managed care experience in utilization management, care management, care transitions, behavioral health, LTSS, or special programs; an equivalent combination of relevant education and experience is acceptable.
At least 1 year of management or leadership experience.
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 of Social Work (LMSW).
Clinical licensure or certification is required only when mandated by the state contract, regulation, business operating model, or state board; any license held must be active and unrestricted in the state of practice.
Strong customer service skills and a member-centric focus.
Ability to work in varied settings and adjust working style, including with diverse populations, personalities, and personal situations.
Ability to prioritize and manage multiple deadlines.
Strong organizational and problem-solving skills.
Ability to collaborate cross-functionally in a highly matrixed organization.
Strong written and verbal communication skills.
Proficiency with Microsoft Office and applicable software programs.

Nice To Haves

Clinical experience.
Registered Nurse (RN) or master's-level behavioral health licensure; any license must be active and unrestricted 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.

Responsibilities

Oversee team performance across one or more healthcare services functions, such as care management, utilization management, care transitions, behavioral health, LTSS, or special programs.
Facilitate integrated, proactive healthcare services management and ensure compliance with regulatory and accrediting standards and implementation of the Molina clinical model.
Assess systems, daily operations, and service-delivery efficiency as a hands-on leader.
Ensure adequate staffing and service levels and monitor staff productivity, performance indicators, and customer satisfaction.
Assist with implementing healthcare services programs in accordance with regulatory requirements, contract standards, and accreditation requirements.
Ensure member care and services meet Molina’s customer service standards.
Ensure high-risk and complex members receive adequate support.
Monitor performance, protocols, and guidelines related to healthcare services.
Keep senior healthcare services leadership informed about operational issues, staffing, resources, systems, and program needs.
Promote interdepartmental and multidisciplinary collaboration to improve continuity of care.
Oversee interdisciplinary care team (ICT) meetings.
Analyze and report statistics on care access and monitoring, including plan utilization, staff productivity, cost-effective service utilization, targeted population management, and triage activities.
Ensure staff quality audit reviews are completed; evaluate services and outcomes and recommend program or staff-development improvements for cost-effectiveness and compliance.
Maintain professional relationships with providers, internal and external customers, and state agencies as appropriate.
Identify opportunities to improve care delivery, quality, and operations.
Hire, train, develop, and manage the team; ensure accountability for team performance and departmental goals.
Travel locally when required by state or contractual requirements.