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Healthcare Services Manager
2 months ago
JOB DESCRIPTION
We are looking for a qualified (RN) Registered Nurse or Licensed Mental Health Professional (LMHP) who is licensed in the state of VIRGINIA.
The Manager will oversee a team of Nurse Case Managers working within our Medicaid program. We seek an individual with robust leadership skills and experience managing direct reports. Previous experience in 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 for leadership meetings may be required.
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 needed to support the team.
Job Summary
Molina Healthcare Services (HCS) collaborates with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate an integrated delivery of care across various settings, including behavioral health and long-term care, for members with significant needs. HCS staff work diligently to ensure that patients progress toward their desired outcomes with quality care that is both medically appropriate and cost-effective based on the severity of their conditions and the service locations.
KNOWLEDGE/SKILLS/ABILITIES
The Manager, Healthcare Services is responsible for the operational management and oversight of integrated Healthcare Services (HCS) teams that ensure Molina Healthcare members receive appropriate care at the right time and place, assisting them in achieving optimal clinical, financial, and quality of life outcomes.
- Oversee clinical teams (including operational teams, where integrated) performing activities such as care review/utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), case management, transition of care, health management, and member assessments.
- Through direct report supervisors, facilitate integrated, proactive HCS management, ensuring compliance with state and federal regulations and the implementation of the Molina Clinical Model.
- Manage and evaluate team member performance; provide coaching, counseling, employee development, and recognition; ensure ongoing, appropriate staff training; and oversee the selection, orientation, and mentoring of new staff.
- Promote interdepartmental and multidisciplinary integration and collaboration to enhance continuity of care, including Behavioral Health and Long-Term Services & Supports for Molina members. Supervise Interdisciplinary Care Team meetings.
- Function as a hands-on manager responsible for supervising and coordinating daily integrated healthcare service activities.
- Ensure adequate staffing and service levels while maintaining customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
- Compile and report on Care Access and Monitoring statistics, including plan utilization, staff productivity, cost-effective service utilization, management of targeted member populations, and triage activities.
- Ensure completion of staff quality audit reviews. Evaluate services provided and outcomes achieved, recommending enhancements/improvements for programs and staff development to ensure consistent cost-effectiveness and compliance with all state and federal regulations and guidelines.
- Maintain professional relationships with the provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement.
JOB QUALIFICATIONS
Required Education
- Registered Nurse or an equivalent combination of Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with relevant experience in lieu of RN license.
- OR Bachelor's or master's degree in Nursing, Gerontology, Public Health, Social Work, or a related field.
Required Experience
- 5+ years of managed healthcare experience, including 3 or more years in one or more of the following areas: utilization management, case management, care transition, and/or disease management.
- Minimum 2 years of supervisory or managerial experience in healthcare or health plans, including oversight of clinical staff.
- Experience working within applicable state, federal, and third-party regulations.
Required License, Certification, Association
- If licensed, the license must be active, unrestricted, and in good standing.
- Must possess a valid driver's license with a good driving record and be able to drive within applicable state or locality with reliable transportation.
Preferred Education
Master's Degree preferred.
Preferred Experience
- 3+ years of supervisory/management experience in a managed healthcare environment.
- Experience with Medicaid/Medicare populations with increasing responsibility.
- 3+ years of clinical nursing experience.
Preferred License, Certification, Association
Any of the following:
Certified Case Manager (CCM), Certified Professional in Healthcare Management Certification (CPHM), Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $65, $142,548.59 / ANNUAL
*Actual compensation may vary based on geographic location, work experience, education, and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to individuals receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, bring your passion and talents, and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time