Manager, Healthcare Services

Molina Healthcare•Long Beach, FL

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 delivery and coordination of care across the continuum, while contributing to the strategy for quality and cost-effective member care. This is a hands-on leadership role focused on team performance, day-to-day operations, service efficiency, staffing, regulatory compliance, customer satisfaction, and quality improvement. The manager coordinates with senior healthcare services leadership and multidisciplinary partners, oversees interdisciplinary care team meetings, supports high-risk and complex members, and develops staff to achieve departmental goals. 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.
An RN, LVN, LPN, LCSW, LMFT, LPCC, or LMSW credential. 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 adapt 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.
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 for one or more healthcare services functions, such as care management, utilization management, transitions of care, behavioral health, LTSS, or special programs.
Facilitate integrated, proactive healthcare services management in compliance with regulatory and accrediting standards and Molina’s clinical model.
Assess and evaluate systems, day-to-day operations, and service-delivery efficiency as a hands-on leader.
Ensure adequate staffing and service levels, and maintain customer satisfaction by monitoring staff productivity and other performance indicators.
Assist with implementing healthcare services programs 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 meetings.
Analyze and report statistics on care access and monitoring, plan utilization, staff productivity, cost-effective service utilization, targeted member populations, and triage activities.
Ensure staff quality audit reviews are completed; evaluate services and outcomes and recommend program improvements and staff development.
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; take accountability for team performance and departmental goals.
Travel locally when required by state or contractual requirements.