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Manager, Healthcare Services

Manager, Healthcare Services

Veterans StaffingGreen Bay, WI, US
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Manager, Healthcare Services

Molina Healthcare Services (HCS) works with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

The Manager, Healthcare Services provides operational management and oversight of integrated Healthcare Services (HCS) teams responsible for providing Molina Healthcare members with the right care at the right place at the right time and assisting them to achieve optimal clinical, financial, and quality of life outcomes.

Responsibilities include :

  • Responsible for clinical teams performing one or more of the following activities : care review / utilization management, case management, transition of care, health management, and / or member assessment.
  • Facilitates integrated, proactive HCS management, ensuring compliance with state and federal regulatory and accrediting standards.
  • Manages and evaluates team member performance, provides coaching, counseling, employee development, and recognition.
  • Performs and promotes interdepartmental / multidisciplinary integration and collaboration to enhance the continuity of care including Behavioral Health and Long-Term Services & Supports for Molina members.
  • Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities.
  • Ensures adequate staffing and service levels, maintains customer satisfaction by implementing and monitoring staff productivity.
  • Collates and reports on Care Access and Monitoring statistics.
  • Ensures completion of staff quality audit reviews.
  • Maintains professional relationships with provider community, internal and external customers, and state agencies.

Job Qualifications : Required Education :

  • Registered Nurse or equivalent combination of Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license.
  • OR Bachelor's or master's degree in Nursing, Gerontology, Public Health, Social Work, or 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 healthcare or health plan supervisory or managerial experience, including oversight of clinical staff.
  • Experience working within applicable state, federal, and third-party regulations.

    • Required License, Certification, Association :

  • If licensed, license must be active, unrestricted, and in good standing.
  • Must have valid driver's license with 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 supervisory / management experience in a managed healthcare environment.
  • Medicaid / Medicare Population experience 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.

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    Healthcare Manager • Green Bay, WI, US