Manager, Healthcare Services (Milwaukee County, WI)

Molina Healthcare•Long Beach, CA

About The Position

Leads and manages a multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care. The manager oversees team performance and day-to-day operations, helps ensure adequate staffing and service levels, and monitors productivity, customer satisfaction, quality, and compliance. The role supports high-risk and complex members, promotes collaboration across departments and disciplines, and maintains relationships with providers, customers, and state agencies. 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 be considered.
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 mandated by state contract, regulation, business operating model, or state licensing 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 approach, 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 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 in compliance with state and federal regulatory and accrediting standards and Molina's clinical model.
Assist with evaluating systems, day-to-day operations, and efficiency of services and care delivery.
Ensure adequate staffing and service levels and maintain customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
Assist in implementing healthcare services programs in accordance with regulatory and contractual 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 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 meetings.
Analyze and report on care access and monitoring statistics, including plan utilization, staff productivity, cost-effective service utilization, targeted member population management, and triage activities.
Ensure completion of staff quality audit reviews; evaluate services and outcomes; and recommend program and staff development improvements to promote 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.