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Healthcare Services Manager
2 months ago
JOB OVERVIEW
We are looking for a dedicated professional to fill the role of Manager, Healthcare Services. This position requires a (RN) Registered Nurse or LMHP residing in VIRGINIA, holding a valid license for the state.
The Manager will oversee a team of Nurse Case Managers in the field, focusing on our Medicaid program. We seek an individual with robust leadership skills and substantial experience managing direct reports. Previous experience in Managed Care Organizations (MCO) is highly desirable.
This role is remote, allowing flexibility to work from anywhere within Virginia, with occasional travel to the Richmond VA office for leadership meetings as necessary.
A home office equipped with high-speed internet is essential.
Core business hours are Monday to Friday, from 8 AM to 5 PM EST, with some 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 various settings, 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.
KEY RESPONSIBILITIES
- Provide operational management and oversight of integrated Healthcare Services (HCS) teams to ensure Molina Healthcare members receive timely and appropriate care.
- Supervise clinical teams engaged in care review, utilization management, case management, health management, and member assessments.
- Facilitate integrated HCS management through direct report supervisors, ensuring compliance with regulatory standards and implementation of the Molina Clinical Model.
- Manage team performance, offering coaching, employee development, and recognition while ensuring ongoing training and mentoring for new staff.
- Promote interdepartmental collaboration to enhance continuity of care, including Behavioral Health and Long-Term Services & Supports.
- Oversee daily healthcare service activities, ensuring adequate staffing and maintaining customer satisfaction through performance monitoring.
- Analyze and report on Care Access and Monitoring statistics, including utilization and productivity metrics.
- Conduct quality audits and recommend improvements for programs and staff development to ensure compliance with regulations.
- Maintain professional relationships with providers, customers, and state agencies, identifying opportunities for service enhancement.
QUALIFICATIONS
Required Education
- Registered Nurse or 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
- A minimum of 5 years in managed healthcare, including at least 3 years in utilization management, case management, or related areas.
- At least 2 years of supervisory or managerial experience in a healthcare setting, 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
A Master's Degree is preferred.
Preferred Experience
- 3+ years of supervisory or management experience in a managed healthcare environment.
- 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.
COMPENSATION
Pay Range: $65,000 - $142,548.59 annually. Actual compensation may vary based on geographic location, work experience, education, and skill level.
ABOUT MOLINA HEALTHCARE
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 shares our mission to make a difference in the lives of others.
