VP, Healthcare Services (Nevada)

Molina Healthcare•Long Beach, CA

11d

About The Position

Provides executive-level strategy and leadership to multidisciplinary healthcare services professionals across functions that may include care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, partners with executive leadership to align services with business goals, and contributes to the strategy for providing quality, cost-effective member care. The role oversees strategy, clinical and operational performance, staffing, budgets, regulatory and contractual compliance, program implementation, process improvement, analytics, and collaboration across teams and external stakeholders. It also hires, develops, and manages a high-performing team. Local travel may be required based on state or contractual requirements.

Requirements

At least 12 years of healthcare experience, including at least 10 years of managed-care experience in one or more of utilization management, care management, care transitions, behavioral health, LTSS, or special programs; an equivalent combination of relevant education and experience is also accepted.
At least 7 years of management or leadership experience.
A professional credential as an 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.
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 adapt 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, vision, and direction for one or more healthcare services functions; take accountability for performance and financial results and keep executive leadership informed.
Determine strategic clinical, quality, and financial measures for success.
Facilitate integrated, proactive healthcare services management in compliance with state and federal regulations and accrediting standards, and implement the Molina clinical model.
Oversee state plan implementation of an integrated service model that manages health service needs together with medical care needs to address members’ whole-health needs, improve 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 supporting proactive care coordination, care review, and management.
Ensure adequate staffing and service levels and maintain customer satisfaction by monitoring staff productivity and other performance indicators.
Collaborate with the chief medical officer and medical director team on clinical policy processes that meet healthcare cost and quality targets.
Develop initiatives to reduce medical expenses within budget targets and increase quality scores.
Oversee care management, utilization management, behavioral health, care transitions, LTSS, and other program activities in accordance with regulatory, contractual, and accreditation requirements.
Ensure member care and services meet Molina’s customer service standards.
Monitor healthcare services performance, protocols, and guidelines.
Inform senior leadership of operational issues, staffing, resources, systems, and program needs, and present remediation solutions and action plans.
Promote cross-departmental and multidisciplinary collaboration and continuity of care, including oversight of interdisciplinary care team meetings.
Ensure staff quality audit reviews are completed; evaluate services and outcomes; and recommend program, service, and staff-development improvements to promote cost-effectiveness and compliance.
Refine operational processes and lead reviews of team processes, workflows, and activities.
Ensure contractual obligations are met or exceeded.
Manage analytical studies that measure healthcare services program benefits, appropriate resource allocation, operational controls, and efficiencies.
Analyze and report care access and monitoring statistics, including plan utilization, staff productivity, cost-effective service utilization, targeted-population management, and triage activities.
Oversee successful implementation of healthcare services for new business and expansions.
Identify and review products and approaches that may improve care delivery, safety-net planning, levels of care, outcomes, cost offsets, predictive modeling, medical-care-management integration, or support for the patient-centered medical home.
Communicate project requirements and anticipated outcomes to the Molina 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.
Facilitate and participate in committees, task forces, work groups, and multidisciplinary teams to promote standardized enterprise-wide healthcare services programs.
Attend local, state, or national 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 state regulators, providers, community service agencies, advocacy groups, and other stakeholders.
Maintain professional relationships with providers, internal and external customers, and state agencies as appropriate.
Hire, train, develop, and manage the team; ensure team performance and achievement of department-specific goals.
Build and sustain a high-performance team that attracts, develops, and retains talent in support of strategy and long-term business objectives.
Travel locally when required by state or contractual requirements.