VP, Healthcare Services (Nevada)

Molina Healthcare•Long Beach, NV

10d

About The Position

Provides executive-level strategy and leadership for multidisciplinary 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 reach desired outcomes through integrated care delivery and coordination across the continuum, aligns healthcare services with business goals, and contributes to strategies for quality, cost-effective member care. The role oversees state plan implementation of integrated services, regulatory and contractual compliance, performance and financial results, staffing and service levels, budgets, clinical and operational protocols, quality monitoring, and initiatives to improve outcomes and control costs. It collaborates with executive leadership, the chief medical officer, medical directors, internal teams, providers, regulators, and community stakeholders. The position also leads and develops teams, supports new business and program implementation, represents Molina in external meetings, and may require local travel based on state or contractual requirements.

Requirements

At least 12 years of healthcare experience, including at least 10 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.
At least 7 years of management or leadership experience.
A credential as an RN, LVN, LPN, LCSW, LMFT, LPCC, or LMSW. Clinical licensure or certification is required only when mandated by state contract, regulation, business operating model, or state licensing rules; any license held must be active and unrestricted in the state of practice.
Experience working within applicable state, federal, and third-party regulations.
Strong customer service skills and a member-centric focus.
Ability to work in varied settings and adjust style, including when working with diverse populations, personalities, and personal situations.
Data analysis and critical-thinking skills.
Ability to prioritize and manage multiple deadlines.
Strong organizational and problem-solving skills.
Operational and process improvement experience.
Ability to collaborate cross-functionally in a highly matrixed organization.
Ability to manage conflict and lead through change.
Excellent 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 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

Support executive health plan or enterprise strategy development, vision, and direction for healthcare services functions.
Account for performance and financial results and keep executive leadership informed.
Determine strategic clinical, quality, and financial measures of success.
Facilitate integrated, proactive healthcare services management in compliance with applicable regulations and accrediting standards and implement the Molina clinical model.
Oversee state plan implementation of an integrated service model that addresses members’ whole-health needs and promotes improved outcomes and lower costs.
Integrate care coordination, care transitions, long-term care, behavioral health, chemical dependency, and other special programs.
Develop, implement, and monitor standardized protocols for clinical and non-clinical team activities.
Ensure adequate staffing and service levels and monitor staff productivity and other performance indicators to maintain customer satisfaction.
Collaborate with the chief medical officer and medical director team on clinical policy processes that meet cost and quality targets.
Develop initiatives to reduce medical expenses and increase quality scores.
Oversee healthcare services program activities in accordance with regulatory, contractual, and accreditation requirements.
Ensure member care and services align with Molina’s customer service standards.
Monitor healthcare services performance, protocols, and guidelines.
Report operational issues, staffing, resource, system, and program needs to senior leadership and present remediation solutions or action plans.
Promote multidisciplinary collaboration and oversee interdisciplinary care team meetings.
Ensure completion of staff quality audits, evaluate services and outcomes, and recommend program or staff-development improvements.
Refine operational processes and lead reviews of team workflows and activities.
Ensure compliance with contractual obligations and required standards.
Manage analytical studies that measure program benefits, resource allocation, operational controls, and efficiency.
Analyze and report care access and monitoring statistics, including utilization, productivity, cost-effective service use, targeted-population management, and triage activities.
Oversee implementation of healthcare services for new business and expansions.
Identify and review products and approaches to enhance care delivery, safety-net planning, alternative levels of care, predictive modeling, integration with medical care management, and patient-centered medical homes.
Communicate project requirements and anticipated outcomes to the project management office for initiatives intended to improve clinical operations efficiency and meet cost and quality goals.
Develop the healthcare services department budget and ensure budget targets are met.
Participate in committees, task forces, work groups, and multidisciplinary teams to promote standardized enterprise-wide healthcare services programs.
Attend conferences as needed to maintain current knowledge of behavioral health best practices, service delivery models, and state initiatives.
Represent Molina in external healthcare services management meetings with regulators, providers, community service agencies, advocacy groups, and other stakeholders.
Maintain professional relationships with providers, internal and external customers, and state agencies.
Hire, train, develop, and manage the team, taking accountability for its performance and department goals.
Build and sustain a high-performing team by attracting, developing, and retaining talent.
Travel locally as required by state or contractual requirements.