Supervisor, Healthcare Services

JOB DESCRIPTION Job Summary Leads and supervises a multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care. *PST Hours* Essential Job Duties • Oversees team performance for one or more of the following healthcare services functions: care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition of care, behavioral health, long-term services and supports (LTSS), and/or special programs. • Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model. • Functions as a “hands-on” leader - assisting with assessing and evaluation of systems, day-to-day operations and efficiency of services/care delivery. • Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators. • Assists in implementing care management, utilization management, behavioral health, care transitions, LTSS and other program activities in accordance with regulatory, contract standards and accreditation compliance. • Ensures delivery of member care and services are aligned with Molina's established standards of customer service excellence. • Ensures high-risk, complex members are adequately supported. • Oversees ongoing monitoring of performance, protocols and guidelines related to healthcare services. • Collaborates with and keeps senior level healthcare services leadership apprised of operational issues, staffing, resources, system and program needs. • Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care. • Oversees interdisciplinary care team (ICT) meetings. • Analyzes and reports on care access and monitoring statistics including plan utilization, staff productivity, cost-effective utilization of services, management of targeted member population, and triage activities. • Ensures completion of staff quality audit reviews evaluates services provided, outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost-effectiveness and compliance with all state and federal regulations and guidelines. • Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate. • Identifies opportunities for care delivery/quality/operational/etc. process improvements. • Hires, trains, develops and manages team demonstrates accountability for team performance and achievement of department-specific goals. • Local travel may be required (based upon state/contractual requirements).

Required Qualifications • At least 5 years of health care experience, including at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or special programs, or equivalent combination of relevant education and experience, or equivalent combination of relevant education and experience. • Registered Nurse (RN), Licensed Vocational Nurse (LVN), and Licensed Practical Nurse (LPN). If licensed, license must be active and unrestricted in state of practice. • Strong customer service skills/member-centric focus. • Ability to work within a variety of settings and adjust style as needed, including ability to work with