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Manager of Integrated Healthcare Services
2 months ago
Position Overview
Molina Healthcare Services (HCS) collaborates with members, healthcare providers, and multidisciplinary teams to evaluate, facilitate, plan, and coordinate a comprehensive delivery of care across various settings, including behavioral health and long-term care, for members with significant needs. The HCS team is dedicated to ensuring that patients achieve their desired health outcomes through quality care that is both medically appropriate and cost-effective, tailored to the severity of their conditions and the service locations.
KEY RESPONSIBILITIES
The Manager of Healthcare Services is responsible for the 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.
- Oversees clinical teams engaged in activities such as care review/utilization management (including prior authorizations and medical necessity assessments), case management, transitions of care, health management, and member evaluations.
- Facilitates integrated and proactive management of HCS through direct report supervisors, ensuring adherence to state and federal regulations and the implementation of the Molina Clinical Model.
- Evaluates team member performance, providing coaching, counseling, and professional development opportunities; ensures comprehensive staff training and is responsible for the recruitment, orientation, and mentoring of new personnel.
- Promotes interdepartmental and multidisciplinary collaboration to enhance continuity of care, including Behavioral Health and Long-Term Services & Supports for Molina members, and oversees Interdisciplinary Care Team meetings.
- Acts as a hands-on manager, supervising and coordinating daily integrated healthcare service operations.
- Ensures adequate staffing levels and maintains customer satisfaction by monitoring staff productivity and other performance metrics.
- Collects and analyzes Care Access and Monitoring statistics, including plan utilization, staff productivity, and effective service utilization management.
- Conducts staff quality audit reviews, evaluates service delivery and outcomes, and recommends enhancements for program and staff development to ensure compliance with all relevant regulations.
- Maintains professional relationships with the provider community, internal and external stakeholders, and regulatory agencies, while identifying areas for improvement.
Required Education
- Registered Nurse or a combination of Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) experience in lieu of RN license.
- OR a Bachelor's or Master's degree in Nursing, Gerontology, Public Health, Social Work, or a related field.
- 5+ years of experience in managed healthcare, including at least 3 years in areas such as utilization management, case management, care transitions, or disease management.
- A minimum of 2 years in a supervisory or managerial role within a healthcare or health plan setting, overseeing clinical staff.
- Experience with applicable state, federal, and third-party regulations.
- If licensed, the license must be active, unrestricted, and in good standing.
- Must possess a valid driver's license with a clean driving record and be able to travel as needed.
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.
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.
About Molina Healthcare
Molina Healthcare is a nationwide Fortune 500 organization committed to providing quality healthcare to individuals receiving government assistance. We offer a competitive benefits and compensation package and are an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time
