Manager, Healthcare Services (RN) Registered Nurse ( ...

California resident preferred. JOB DESCRIPTION Job Summary Leads and manages 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 other 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 u2022 Responsible for leading and managing performance of one or more of the following activities: care review, care management, transition of care, health management, behavioral health, long-term services and supports (LTSS), and/or member assessment. u2022 Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model. u2022 Manages and evaluates team member performance, provides coaching, employee development and recognition, ensures ongoing appropriate staff training, and has responsibility for selection, orientation and mentoring of new staff. u2022 Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care. u2022 Oversees interdisciplinary care team (ICT) meetings. u2022 Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities. u2022 Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators. u2022 Collates 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. u2022 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. u2022 Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement. u2022 Local travel may be required (based upon state/contractual requirements). Required Qualifications u2022 At least 7 years experience in health care, and at least 3 years of managed care experienced in one or more of the following areas: care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. u2022 At least 1 year of health care management leadership experience. u2022 Registered Nurse (RN). License must be active and unrestricted in state of practice. u2022 Experience working within applicable state, federal, and third party regulations. u2022 Demonstrated knowledge of community resources. u2022 Proactive and detail-oriented. u2022 Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. u2022 Ability to work independently, with minimal supervision and demonstrate self-motivation. u2022 Responsive in all forms of communication, and ability to remain calm in high-pressure situations. u2022 Ability to develop and maintain professional relationships. u2022 Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. u2022 Excellent problem-solving and critical-thinking skills. u2022 Excellent verbal and written communication skills. u2022 Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications u2022 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. u2022 Medicaid/Medicare population experience. u2022 Clinical experience. Work Schedule: California Pacific Time Zone, daytime business hours. Candidates who do not live in CA must work Pacific hours permanently. 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 Pay Range: $84,067 - $163,931 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-10-04