VP, Healthcare Services

JOB DESCRIPTION Job Summary Provides executive level strategy and leadership to a multidisciplinary team of healthcare services professionals, in some or all of the following functions: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), and other clinical programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Partners with executive leadership team to provide cohesive direction towards company goals. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties u2022 Supports executive strategy development, vision and direction for healthcare services teams including care management, care coordination, transitions of care, utilization management (prior-authorization, inpatient review), behavioral health, long-term services and supports (LTSS), and other member care focused programs. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. u2022 Collaborates with the chief medical officer and medical director team to develop and implement processes to effectively manage clinical policies to meet health care cost and quality targets. u2022 Collaborates with healthcare services and clinical operations teams at the corporate and/or health plan level to achieve successful implementation of Molina clinical strategy and direction. u2022 Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operations functions and promote quality cost-effective health care for Molina members. u2022 Mentors, guides and develops skills of healthcare services leaders and team members in a consistent and effective manner. u2022 Develops initiatives to achieve budgeted reductions in medical expenses and increases in quality scores. u2022 Develops health care services department budget and ensures budget targets are met. u2022 Manages implementation of analytical studies that quantify the benefits of healthcare services programs to ensure that resources are appropriately allocated, operational controls exist, and efficiencies are maximized. u2022 Facilitates integration of care coordination, care transitions, long-term care, behavioral health, chemical dependency and other special programs. u2022 Continually refines operational processes and champions review of team processes, workflows and activities. u2022 Articulates project requirements and anticipated outcomes to the Molina project management office for identified projects/strategies to improve the efficiency of clinical operations teams to meet cost and quality goals. u2022 Accountable for ensuring compliance with contractual, accreditation and regulatory requirements for all healthcare services teams. u2022 Participates personally or assigns appropriate staff to Molina quality committees and external community committees to represent the healthcare services department. u2022 Ensures effective interdepartmental collaboration and interaction between healthcare services staff and other departments. u2022 Ensures monthly auditing of healthcare services staff is performed and appropriate actions and/or coaching occur. u2022 Demonstrates oversight of clinical training activities and outcomes. u2022 Demonstrates accountability for healthcare services related delegation oversight monitoring. Required Qualifications u2022 At least 12 years experience in health care, and at least 10 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), and progressive experience in clinical operations, or equivalent combination of relevant education and experience. u2022 At least 7 years health care management/leadership experience. u2022 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 or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. u2022 Experience working within applicable state, federal, and third party regulations. u2022 Operational and process improvement experience. u2022 Strong interpersonal skills. u2022 Strong leadership capabilities, and ability to initiate and maintain cross-team relationships and manage change. u2022 Demonstrated experience meeting quality accreditation standards (National Committee for Quality Assurance (NCQA)/Healthcare Effectiveness Data Information Set (HEDIS)/Medicare STARS). u2022 Excellent organizational and time-management skills. u2022 Flexibility in the work environment and willingness and ability to adapt to changing organizational needs. u2022 Excellent verbal and written communication skills. u2022 Microsoft Office suite (including Excel), and applicable software program(s) proficiency. Preferred Qualifications u2022 Registered Nurse (RN). License must be active and unrestricted in state of practice. u2022 Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ) or other health care or management certification. u2022 Medicaid/Medicare population experience. u2022 Clinical experience. u2022 Familiarity and experience with local market/health plan. 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: $161,914.25 - $315,733 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-11-17