Supervisor, Healthcare Services

Molina Healthcare•Long Beach, FL

About The Position

Leads and supervises a multidisciplinary team of healthcare services professionals in functions that may include care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and special programs. The role helps members achieve 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 oversees team performance and day-to-day operations, supports compliance with regulatory and accreditation standards, and helps implement the Molina clinical model. The position also monitors staffing, service levels, productivity, quality, and program outcomes; supports high-risk and complex members; and works with internal teams, providers, customers, and state agencies to improve continuity and quality of care. 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; or an equivalent combination of relevant education and experience.
One of the following credentials: Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (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.
Registered Nurse (RN) or master's-level behavioral health (BH) 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, care transitions, behavioral health, LTSS, or special programs.
Facilitate integrated, proactive healthcare services management in compliance with state and federal regulations and accrediting standards, and support implementation of the Molina clinical model.
Assess systems, day-to-day operations, and service and care-delivery efficiency as a hands-on leader.
Ensure adequate staffing and service levels, and monitor staff productivity and other performance indicators to maintain customer satisfaction.
Assist with implementing healthcare services program activities in accordance with regulatory, contract, and accreditation requirements.
Ensure member care and services meet Molina customer service standards and that high-risk, complex members are adequately supported.
Monitor 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 improve 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 utilization of services, targeted member populations, and triage activities.
Ensure staff quality audit reviews are completed; evaluate services and outcomes; and recommend program and staff-development improvements for 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; take accountability for team performance and department-specific goals.
Travel locally when required by state or contractual requirements.