Manager, Healthcare Services

Molina Healthcare•Long Beach, CA

16h

About The Position

Leads and manages a multidisciplinary team of healthcare services professionals in 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 delivery and coordination of care across the continuum, and contributes to the strategy for providing quality, cost-effective member care. The role is a hands-on leadership position focused on team performance, daily operations, service efficiency, staffing, regulatory compliance, member support, and continuous improvement. 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 also accepted.
At least 1 year of management or leadership experience.
Must hold one of the following credentials: 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 mandate. 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 style as needed, including when working with diverse populations, different 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 in 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 while ensuring compliance with state and federal regulations, accrediting standards, and the Molina clinical model.
Assess and evaluate 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 staff productivity and other performance indicators.
Assist with implementing healthcare program activities 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 are adequately supported.
Oversee ongoing monitoring of 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 enhance 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 member 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; ensure accountability for team performance and department goals.
Travel locally when required by state or contractual requirements.