Supervisor, Healthcare Services (REMOTE) - TX ONLY

Molina Healthcare•TX, TX

3d•$66,456 - $129,590•Remote

About The Position

The Supervisor, Healthcare Services leads and supervises 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. The role supports members in achieving desired outcomes through integrated care delivery and coordination across the continuum, while contributing to the strategy for providing quality, cost-effective member care. The supervisor provides hands-on operational leadership, supports regulatory and accreditation compliance, and monitors staffing, service levels, staff productivity, quality, and program performance. The role works collaboratively across departments and with providers, customers, state agencies, and senior healthcare services leadership. 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 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 adjust working style, including when supporting 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 for 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 implementation of the Molina clinical model.
Assist with assessing and evaluating systems, day-to-day operations, and service and care-delivery efficiency.
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 and program activities in accordance with regulatory requirements, contract standards, and accreditation requirements.
Ensure member care and services align with 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 integration and collaboration to enhance continuity of care.
Oversee interdisciplinary care team (ICT) 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 enhancements and staff development to support cost-effectiveness and compliance.
Maintain professional relationships with the provider community, internal and external customers, and state agencies as appropriate.
Identify opportunities for improvement in care delivery, quality, and operations.
Hire, train, develop, and manage the team, and demonstrate accountability for team performance and department-specific goals.
Travel locally when required by state or contractual requirements.