Job Details

Job Description

JOB DESCRIPTION Job Summary

Leads and manages a team supporting non-clinical healthcare services activities for care management, care review, utilization management, transitions of care, behavioral health, long-term services and supports (LTSS), and/or other program specific service support - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Provides oversight for non-clinical operational teams that support one or more of the following healthcare services functions: care review, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), care management, transitions of care, health management, long-term services and supports (LTSS), behavioral health, member assessment and/or other special programs.
• Facilitates integrated proactive management, ensuring compliance with state, federal, regulatory and accrediting standards.
• Responsible for selection, orientation, onboarding and training of new staff
• Manages and evaluates team member performance and provides coaching, mentoring, employee development and recognition.
• Functions as hands-on manager responsible for supervision and coordination of daily activities.
• Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators
• Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care and quality of services provided. .
• Ensures completion of staff quality audit reviews and evaluates services provided and outcomes achieved to recommend enhancements/improvements for program and staff development, and to ensure consistency, cost-effectiveness and compliance with state/federal regulations and guidelines.
• Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement.

Required Qualifications

• At least 7 years of operations or administrative experience in health care, preferably within a managed care setting, or equivalent combination of relevant education and experience.
• At least 1 year of health care management/leadership experience.
• Strong analytic and problem-solving abilities.
• Strong organizational and time-management skills.
• Ability to multi-task and meet project deadlines.
• Attention to detail.
• Ability to build relationships and collaborate cross-functionally.
• Excellent verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.

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To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V