Supervisor, Healthcare Services (REMOTE) - TX ONLY

This a Full Remote job, the offer is available from: United States, Texas (USA)

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.

 

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), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW).  Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates.  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 diverse populations, various personalities and personal situations.
• Ability to prioritize and manage multiple deadlines.
• Strong organizational and problem-solving skills.
• Ability to collaborate cross-functionally within a highly matrixed organization.
• Strong written and verbal communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.
 

Preferred Qualifications

• Management/leadership experience.  
• Clinical experience.  
• Registered Nurse (RN) or master's level behavioral health (BH) licensure.  License must be active and unrestricted in state of practice. 
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. 
• Medicaid/Medicare population experience.


 

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

This offer from "Molina Healthcare" has been enriched by Jobgether.com and got a 0% flex score.
Back to blog

Other Jobs To Apply

Virtual Pharma Account Manager: High-Impact Territory Sales

Principal Business Development Manager Pharma at Waters Corporation: 100% Remote (US)

Dist Design Project Coord - Sr

Market Commentary Writer and Social Editor at Wealthfront: 100% Remote (San Francisco, CA, New York City, NY)

Analyst, Early Career (Full Stack)

Sales Executive, Digital Assets

Senior Pre-Sales Systems Engineer, Enterprise

Remote Enterprise Identity & Security AE

Remote Retirement Inside Sales Specialist

Account Executive, B2B SaaS — Hybrid/Remote

[Remote] Director - Special Investigations (FIU)

Senior Manager, SAP AI Engineering

Associate Director, eCommerce Operations, eProcurement

Manager, Professional Services- Streaming Media

Commercial Sales Engineer - East - Remote

Emerging Fraud Researcher

HubSpot Administrator - Remote

Remote Snowflake Data Lake Support Pro

Investigator, Operational Excellence

Remote Principal Engineer, Identity & Engagement

Crypto Twitter Content Lead: Real-Time & Witty

TikTok Social Programming, Bleacher Report at Warner Bros. Discovery: 100% Remote (NY, GA)

Inbound Sales Call Center Representative

Senior Manager, Compensation & People Analytics (Remote)

Virtual Sales Rep: Fully Remote, No Cold Calls, Great Training

Services Project Coordinator

Dashers - Sign Up and Start Earning

Remote-Eligible Senior Business Analyst: SDLC & Stakeholder Leader

Notary Stamp Order Online | West College Corner, IN

Remote Freelance Japanese Teacher & 1:1 Coach

Audio & Digital Account Executive

Assistant, Contract Administration

Coordinator, People Data Operations (Remote)

Live Entertainment Marketing Coordinator

Global Technical Product Advisor - Off Road

Guest Experience Center Agent / Inside Sales

Remote SEO Content Lead

Remote Diagnostic Technician: Fast, CustomerFocused Support

Navy Medicine Analytics SME — Remote

Digital Evangelist

Workday Solution Architect

Experience Strategy Manager

Part-Time Oncology Data Specialist - Certified (remote)

Technical Support Consultant Analyst (Remote - PST Working Hours)

GL Claims Specialist - Remote

Senior Underwriter - Management Liability

Controller / Director of Finance

Remote AR Analyst I: Collections & Resolution

Senior Sales Executive

Manager, Flight Maintenance - Traveling

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...