Nurse Supervisor, Healthcare Services Utilization ...

California residents preferred JOB DESCRIPTION Job Summary Leads and supervises 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 Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance. u2022 Functions as a u201chands-onu201d supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services. u2022 Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence. u2022 Trains and supports team members to ensure high-risk, complex members are adequately supported. u2022 Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines. u2022 Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs. u2022 Assists with coordination and reporting of department statistics and ongoing client reports, as assigned. u2022 Local travel may be required (based upon state/contractual requirements). Required Qualifications u2022 At least 5 years health care experience, and at least 2 years of managed care experienced utilization management. u2022 Ability to manage conflict and lead through change. u2022 Operational and process improvement experience. u2022 Strong written and verbal communication skills. u2022 Working knowledge of Microsoft Office suite. u2022 Ability to prioritize and manage multiple deadlines. u2022 Excellent organizational, problem-solving and critical-thinking skills. California licensure must be current and in good standing. Preferred Qualifications u2022 LVN (Licensed vocational nurse) or RN (Registered Nurse) . License must be current, active and unrestricted in the state of California. 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. Prior experience with InterQual, MCG guidelines, PEGA and managed care UM processes. u2022 Medicaid/Medicare population experience. u2022 Clinical experience. u2022 Supervisory/leadership experience. Work Schedule: Pacific daytime business hours. Candidates who do not live in California must work Pacific hours permanently. Weekend and holiday support will be required. 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: $76,425 - $149,028 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-10-04