Supervisor, Healthcare Services

Molina Healthcare•United States,

3d•$59,811 - $129,590

About The Position

Leads and supervises a multidisciplinary team of healthcare services professionals across functions such as 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 coordination across the continuum and contributes to the strategy for delivering quality, cost-effective member care. This hands-on leadership role oversees team performance, day-to-day operations, staffing, service levels, and performance indicators. It ensures healthcare services comply with regulatory, contractual, and accreditation standards and align with Molina's clinical model and customer service standards. The supervisor supports high-risk and complex members, oversees interdisciplinary care team meetings and quality audits, analyzes and reports on access, utilization, productivity, costs, targeted populations, and triage activity, and identifies opportunities to improve care delivery and operations. The role hires, trains, develops, and manages staff, collaborates across departments, and maintains relationships with providers, customers, and state agencies. Local travel may be required based on state or contractual requirements.

Requirements

At least 5 years of healthcare experience, including at least 2 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.
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 licensing 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 adjust work style, including 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

Management or leadership experience.
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, transitions of care, behavioral health, LTSS, and special programs.
Facilitate integrated, proactive healthcare services management and ensure compliance with state and federal regulations, accrediting standards, and the Molina clinical model.
Assess systems, day-to-day operations, and the efficiency of services and care delivery as a hands-on leader.
Ensure adequate staffing and service levels, maintain customer satisfaction, and monitor 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 and adequately support high-risk, complex members.
Oversee 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 care access and monitoring statistics, including utilization, productivity, cost-effective service use, 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 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, and maintain accountability for team performance and department-specific goals.
Travel locally when required by state or contractual requirements.