Healthcare Services Manager

2 weeks ago

Glen Allen, Virginia, United States Molina Healthcare Full time

JOB OVERVIEW

We are currently seeking a qualified (RN) Registered Nurse or Licensed Mental Health Professional (LMHP) residing in VIRGINIA, with an active license for the state.

The Manager will oversee a team of Nurse Case Managers dedicated to our Medicaid program. We are looking for an individual with strong leadership skills and a proven track record in managing direct reports. Previous experience with Managed Care Organizations (MCO) is highly desirable.

This position is remote, allowing you to work from anywhere within Virginia.

Occasional travel to the Richmond VA office will be required for leadership meetings.

A home office with high-speed internet connectivity is essential.

Core business hours are Monday to Friday, 8 AM to 5 PM EST, with flexibility required to support the team.

POSITION SUMMARY

Molina Healthcare Services (HCS) collaborates with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care for members with significant needs. HCS staff are committed to ensuring that patients achieve desired outcomes through quality care that is both medically appropriate and cost-effective, tailored to the severity of illness and the site of service.

KEY RESPONSIBILITIES

  • The Manager, Healthcare Services is responsible for operational management and oversight of integrated Healthcare Services (HCS) teams that provide Molina Healthcare members with timely and appropriate care, aiming for optimal clinical, financial, and quality of life outcomes.
  • Manages clinical teams performing activities such as care review/utilization management, case management, transition of care, health management, and member assessments.
  • Through direct report supervisors, facilitates proactive HCS management, ensuring compliance with regulatory standards and implementation of the Molina Clinical Model.
  • Evaluates team member performance, provides coaching and development, and ensures ongoing staff training while overseeing the selection and orientation of new hires.
  • Promotes interdepartmental collaboration to enhance continuity of care, including Behavioral Health and Long-Term Services & Supports for Molina members.
  • Acts as a hands-on manager responsible for supervising and coordinating daily integrated healthcare service activities.
  • Ensures adequate staffing levels and maintains customer satisfaction by monitoring staff productivity and performance indicators.
  • Collects and reports on Care Access and Monitoring statistics, including plan utilization and management of targeted member populations.
  • Ensures completion of staff quality audits and evaluates services provided, recommending enhancements for program and staff development.
  • Maintains professional relationships with the provider community and state agencies while identifying opportunities for improvement.

QUALIFICATIONS

Required Education

  • Registered Nurse or an equivalent combination of Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with relevant experience.
  • OR a Bachelor's or Master's degree in Nursing, Gerontology, Public Health, Social Work, or a related field.

Required Experience

  • 5+ years of experience in managed healthcare, including at least 3 years in areas such as utilization management, case management, or disease management.
  • Minimum of 2 years in a supervisory or managerial role within healthcare, overseeing clinical staff.
  • Familiarity with applicable state, federal, and third-party regulations.

Required License, Certification, Association

  • Active, unrestricted license in good standing, if applicable.
  • Valid driver's license with a good driving record and reliable transportation.

Preferred Education

Master's Degree is preferred.

Preferred Experience

  • 3+ years of supervisory or management experience in a managed healthcare setting.
  • Experience with Medicaid/Medicare populations with increasing responsibilities.
  • 3+ years of clinical nursing experience.

Preferred License, Certification, Association

Any of the following certifications are preferred: Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), or other relevant healthcare or management certifications.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time

About Us

Molina Healthcare is a nationwide Fortune 500 organization dedicated to providing quality healthcare to individuals receiving government assistance. We are committed to fostering a highly engaged workforce that is passionate about making a difference in the lives of others.

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