Manager, Healthcare Services

Molina Healthcare•Long Beach, IL

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 achieve desired outcomes through integrated care delivery and coordination across the continuum, while contributing to strategies for quality, cost-effective member care. The role is a hands-on leadership position focused on team performance, service operations, regulatory compliance, member outcomes, 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 may qualify.
At least 1 year of management or leadership experience.
A current clinical license or credential as an RN, LVN, LPN, LCSW, LMFT, LPCC, or LMSW. Licensure or certification is required only when required by state contract, regulation, business operating model, or state board mandates; 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 adapt work style, including when 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.
Registered Nurse (RN) or master's-level behavioral health (BH) licensure; any license held 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 and ensure compliance with regulatory and accrediting standards and implementation of the Molina clinical model.
Assess systems, day-to-day operations, and service and care-delivery efficiency as a hands-on leader.
Ensure adequate staffing and service levels, monitor staff productivity and performance indicators, and maintain customer satisfaction.
Assist with implementing healthcare services programs in accordance with regulatory, contractual, and accreditation standards.
Ensure member care and services align with Molina's customer-service standards.
Ensure high-risk and complex members receive adequate support.
Oversee ongoing monitoring of performance, protocols, and healthcare services 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 enhancements and staff development 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-specific goals.
Travel locally when required by state or contractual requirements.