Manager, Healthcare Services

Molina Healthcare•Illinois City, IL

1d•$76,757 - $149,676

About The Position

Leads and manages a multidisciplinary team of healthcare services professionals across one or more functions, 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 delivery and coordination across the continuum, while contributing to the strategy for quality and cost-effective care.

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 also accepted.
At least 1 year of management or leadership experience.
A 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 requirements; 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 approach as needed, including working 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.
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, including care management, utilization management, care transitions, behavioral health, LTSS, and special programs.
Facilitate integrated, proactive healthcare services management in compliance with state and federal regulations, accrediting standards, and the Molina clinical model.
Provide hands-on leadership by assessing systems, day-to-day operations, and the efficiency of services and care delivery.
Ensure adequate staffing and service levels, and maintain customer satisfaction by monitoring productivity and other performance indicators.
Assist with implementing healthcare services programs and activities in accordance with regulatory, contractual, and accreditation requirements.
Ensure member care and services meet Molina's customer service standards.
Ensure high-risk and complex members receive adequate support.
Oversee ongoing monitoring of healthcare services performance, protocols, and guidelines.
Keep senior healthcare services leadership informed about operational issues, staffing, resources, systems, and program needs.
Promote interdepartmental and multidisciplinary collaboration to enhance continuity of care.
Oversee interdisciplinary care team (ICT) meetings.
Analyze and report care access and monitoring statistics, 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 and staff-development improvements to support cost-effectiveness and regulatory 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, and be accountable for team performance and department goals.
Travel locally when required by state or contractual requirements.