AVP, Healthcare Services

JOB DESCRIPTION Job Summary Provides 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 Provides health plan or enterprise strategy development, vision and direction for one or more of the following key health care services (HCS) functions: care management, care transitions, utilization management, behavioral health and/or nurse advice line. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. u2022 Determines clinical, quality, and financial measures for success. u2022 Designs standardized protocols, develops policy and ensures timely implementation with corporate and health plan input. u2022 Ensures adequate training occurs from knowledgeable staff and coordinates with other departments as needed. Focuses on continual refinement of operational processes. u2022 Develops, performs and promotes interdepartmental integration and collaboration to enhance clinical services. u2022 Manages and evaluates team members in the performance of various clinical management activities. u2022 Coordinates with leadership to ensure adequate staffing and service levels, and maintains customer satisfaction by implementing and monitoring staff productivity and performance indicators. u2022 Ensures monthly auditing is occurring with appropriate follow-up. u2022 Engages in clinical training activities and outcomes. u2022 Develops and mentors healthcare services leaders. Required Qualifications u2022 At least 10 years experience in health care, and at least 7 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 equivalent combination of relevant education and experience. u2022 At least 5 years health care management/leadership required. 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 Ability to manage conflict and lead through change. u2022 Operational and process improvement experience. u2022 Ability to work cross-collaboratively across a highly matrixed organization. u2022 Ability to prioritize and manage multiple deadlines. u2022 Excellent organizational, problem-solving and critical-thinking skills. u2022 Strong written and verbal communication skills. u2022 Microsoft Office suite/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 in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ) or other health care or management certification. u2022 Medicaid/Medicare population experience. u2022 Clinical 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 Pay Range: $122,430.44 - $238,739.35 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-12-22