Supervisor, Healthcare Services Utilization Management ( California )

Molina Healthcare • Long Beach, CA

81d • $76,425 - $149,028

About The Position

Leads and supervises 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 other 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.

Requirements

• At least 5 years health care experience, and at least 2 years of managed care experienced utilization management.
• Ability to manage conflict and lead through change.
• Operational and process improvement experience.
• Strong written and verbal communication skills.
• Working knowledge of Microsoft Office suite.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
• California licensure must be current and in good standing.

Nice To Haves

• LVN (Licensed vocational nurse) or RN (Registered Nurse). License must be current, active and unrestricted in the state of California.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
• Prior experience with InterQual, MCG guidelines, PEGA and managed care UM processes.
• Medicaid/Medicare population experience.
• Clinical experience.
• Supervisory/leadership experience.

Responsibilities

• Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.
• Functions as a 'hands-on' supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.
• Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.
• Trains and supports team members to ensure high-risk, complex members are adequately supported.
• Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.
• Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
• Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.
• Local travel may be required (based upon state/contractual requirements).

Benefits

• Competitive benefits and compensation package.

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities