Nurse Supervisor, Healthcare Services Utilization Management ( California )

**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 
• Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance. 
• Functions as a “hands-on” supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services. 
• Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence. 
• Trains and supports team members to ensure high-risk, complex members are adequately supported. 
• Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines. 
• Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs. 
• Assists with coordination and reporting of department statistics and ongoing client reports, as assigned. 
• Local travel may be required (based upon state/contractual requirements). 

Required Qualifications

• At least 5 years health care experience, and at least 2 years of managed care experienced utilization management.
• Ability to manage conflict and lead through change. • Operational and process improvement experience. • Strong written and verbal communication skills. • Working knowledge of Microsoft Office suite. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills.

California licensure must be current and in good standing. 

Preferred Qualifications 
• LVN (Licensed vocational nurse) or RN (Registered Nurse) . License must be current, active and unrestricted in the state of California. 
• 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.
• • Medicaid/Medicare population experience. 
• • Clinical experience. 
• • 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