Manager of Integrated Healthcare Services

2 weeks ago

Milwaukee, Wisconsin, United States Molina Healthcare Full time
JOB DESCRIPTION

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 healthcare 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 environment.

KEY RESPONSIBILITIES

The Manager of Healthcare Services is responsible for the operational management and oversight of integrated Healthcare Services (HCS) teams, ensuring that Molina Healthcare members receive timely and appropriate care, ultimately supporting optimal clinical, financial, and quality of life outcomes.
  • Oversees clinical teams engaged in various activities, including care review/utilization management (prior authorizations, inpatient/outpatient medical necessity assessments), case management, transitions of care, health management, and member evaluations.
  • Facilitates integrated and proactive HCS management 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, employee development, and recognition; ensures ongoing training and is responsible for the recruitment, orientation, and mentoring of new staff.
  • 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 reports on Care Access and Monitoring statistics, including plan utilization, staff productivity, cost-effective service utilization, management of targeted member populations, and triage activities.
  • Conducts staff quality audit reviews, evaluates services and outcomes, and recommends enhancements for programs and staff development to ensure compliance with all applicable regulations.
  • Maintains professional relationships with the provider community, internal and external stakeholders, and state agencies, while identifying opportunities for service improvement.
QUALIFICATIONS

Required Education
  • Registered Nurse or an equivalent 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.
Required Experience
  • 5+ years of experience in managed healthcare, including at least 3 years in areas such as utilization management, case management, care transitions, and/or disease management.
  • A minimum of 2 years of supervisory or managerial experience in a healthcare or health plan setting, including oversight of clinical staff.
  • Experience with 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 is preferred.

Preferred Experience
  • 3+ years of supervisory or 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 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 offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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