Lead, HCS Ops Support - Peds/Adolescent

Job Title

Job SummaryProvides lead level non-clinical healthcare services support for care management, care review, utilization management, transitions of care, behavioral health, long-term services and supports (LTSS), and/or other program specific service support - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Assists in training of staff according to department standards, policies and procedures.
• Evaluates work performance of healthcare services department staff; consults with leadership to devise and implement corrective action as necessary to improve staff performance.
• Acts as a supportive resource to healthcare services department staff, assisting in devising/implementing strategies of assignment delegation and facilitating department processes and communicating/coordinating activities.
• Resolves problems and complaints that may arise in day-to-day operations that involve healthcare services department staff; communicates findings to leadership for resolution.
• Maintains a minimal caseload (as determined by leadership).
• Ensures communication and adherence to appropriate guidelines and support staff with daily operational and administrative compliance activities.
• Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing issues, system and program needs.
• Monitors healthcare services department staff workload for adherence to the department policies, procedures, guidelines and deadlines; ensures oversight and direction of individuals primarily responsible and timely completion.
• Actively participates in department auditing program to review and communicate findings with staff and identify opportunities for improved quality and compliance.
• Acts as liaison to both internal and external customers on behalf of both Molina and healthcare services department areas.
• Conducts in a professional manner at all times; maintains confidentiality, cooperation, effective workplace relationships and adheres to company code of conduct.
• Attends/participates in departmental, company-wide, and external committees, task forces, or work groups as assigned.
• Shares monthly quality and productivity scores with individual staff for awareness.

Required Qualifications

• At least 4 years of operations or administrative experience in health care, preferably within a managed care setting, or equivalent combination of relevant education and experience.
• Excellent customer service skills.
• Strong analytic and problem-solving abilities.
• Strong time-management and organizational skills.
• Strong verbal and written communication skills.
• Microsoft Office suite proficiency (including Excel), and applicable software program(s) proficiency.

Preferred Qualifications

• Certified Medical Assistant (CMA).