Supervisor, Healthcare Services

JOB DESCRIPTION

Job Summary

Leads and supervises a multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.

PST Hours

Essential Job Duties

• Oversees team performance for one or more of the following healthcare services functions: care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition of care, behavioral health, long-term services and supports (LTSS), and/or special programs.

• Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model.

• Functions as a “hands-on” leader - assisting with assessing and evaluation of systems, day-to-day operations and efficiency of services/care delivery.

• Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.

• Assists in implementing care management, utilization management, behavioral health, care transitions, LTSS and other program activities in accordance with regulatory, contract standards and accreditation compliance.

• Ensures delivery of member care and services are aligned with Molina's established standards of customer service excellence.

• Ensures high-risk, complex members are adequately supported.

• Oversees ongoing monitoring of performance, protocols and guidelines related to healthcare services.

• Collaborates with and keeps senior level healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.

• Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care.

• Oversees interdisciplinary care team (ICT) meetings.

• Analyzes and reports on care access and monitoring statistics including plan utilization, staff productivity, cost-effective utilization of services, management of targeted member population, and triage activities.

• Ensures completion of staff quality audit reviews evaluates services provided, outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost-effectiveness and compliance with all state and federal regulations and guidelines.

• Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate.

• Identifies opportunities for care delivery/quality/operational/etc. process improvements.

• Hires, trains, develops and manages team demonstrates accountability for team performance and achievement of department-specific goals.

• Local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 5 years of health care experience, including at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or special programs, or equivalent combination of relevant education and experience, or equivalent combination of relevant education and experience.

• Registered Nurse (RN), Licensed Vocational Nurse (LVN), and Licensed Practical Nurse (LPN). If licensed, license must be active and unrestricted in state of practice.

• Strong customer service skills/member-centric focus.

• Ability to work within a variety of settings and adjust style as needed, including ability to work with diverse populations, various personalities and personal situations.

• Ability to prioritize and manage multiple deadlines.

• Strong organizational and problem-solving skills.

• Ability to collaborate cross-functionally within a highly matrixed organization.

• Strong written and verbal communication skills.

• Microsoft Office suite and applicable software program(s) proficiency.

Preferred Qualifications

• Management/leadership experience.

• Clinical experience.

• Registered Nurse (RN) or master's level behavioral health (BH) licensure. License must be active and unrestricted in state of practice.

• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.

• Medicaid/Medicare population experience.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $59,810.6 - $129,589.63 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.