Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: senior.
Skills: Product ownership, Product Management, Agile, Scrum, Salesforce, Business Analysis.
Job Summary Provides subject matter expertise in the delivery, execution and maintenance of products. Accountable for maximizing the value of assigned technical products that support enterprise operations.
Company: Molina Healthcare
Location: United States
Salary: $63.133k - $129.589k
Job type: full-time. Experience level: mid.
Skills: SQL, Excel, Data Analysis, Healthcare Analytics, Claims Processing, Coding.
Molina Healthcare of Nebraska is hiring for a Senior Analyst, Provider and Claim Data & Analytics. This role is remote for those within the United States. Highly Qualified Candidates Will Have the Following Experience- • Medicaid and managed care • Claims and coding experience.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: senior.
Skills: Product ownership, Product Management, Business Analysis, Agile, Scrum, Backlog management.
Job Summary Provides subject matter expertise in the delivery, execution and maintenance of products. Accountable for maximizing the value of assigned technical products that support enterprise operations.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: SQL, Data mining, Medical economics, Healthcare Analytics, Predictive Modeling, Financial Modeling.
Job Summary Provides senior level analyst support for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Data Analysis, SQL, Microsoft Excel, SSRS, Healthcare Analytics, Pharmacy Claims.
Job Summary Provides senior level analyst support for data analysis and reporting activities. Responsible for organizing data from multiple sources to produce reports, dashboards, and analyses related to utilization, cost-containment, and business performance.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: entry.
Skills: Data Analysis, Healthcare Analytics, Reporting, Excel, SQL, Power BI.
Job Summary Responsible for organizing data from multiple sources to produce reports, dashboards, and analyses related to utilization, cost-containment, and business performance.
Company: Molina Healthcare
Location: United States
Salary: $49.43k - $107.098k
Job type: full-time. Experience level: mid.
Skills: SQL, Data Analysis, Reporting, Excel, SSRS, Data Validation.
Job Summary Provides analyst support for data analysis and reporting activities. This position is ideal for early-career analytical professionals seeking to build expertise in healthcare data analytics.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Regulatory Compliance, Requirement Analysis, Managed Care, Health Insurance, Data Analysis, Problem Management.
Job Summary Responsible for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance.
Company: Molina Healthcare
Location: United States
Salary: $161.914k - $315.732k
Job type: full-time. Experience level: staff.
Skills: Project Management, Portfolio Management, Leadership, Strategic Planning, Agile, Jira.
Job Summary Provides strategy and leadership to team responsible for enterprise project and portfolio management activities. Oversees project and portfolio management across mergers and acquisitions (M&A), growth, and other business initiatives - ensuring successful delivery of programs while…
Company: Molina Healthcare
Location: United States
Salary: $161.914k - $315.732k
Job type: full-time. Experience level: staff.
Skills: Project Management, Portfolio Management, Leadership, Strategic Planning, Agile, Jira.
Job Summary Provides strategy and leadership to team responsible for enterprise project and portfolio management activities. Oversees project and portfolio management across mergers and acquisitions (M&A), growth, and other business initiatives - ensuring successful delivery of programs while…
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: senior.
Skills: Administrative Support, Calendar Management, meeting coordination, Research, Report Preparation, Data Interpretation.
Job Summary Provides administrative level support to an Executive and division team members. Prioritizes management/client requests in order to meet business objectives. Supports the day-to-day administrative operations of the Executive and department.
Company: Molina Healthcare
Location: United States
Salary: $63.435k - $123.699k
Job type: full-time. Experience level: senior.
Skills: Marketing Communications, brand management, Content Development, Project Management, Writing, Editing.
Job Summary Provides subject matter expertise and leadership for health plan communications and marketing activities for the Nevada Health Plan. Responsible for developing internal and external brand aligned communications and marketing campaigns, including marketing and communications materials…
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Risk Adjustment, Quality Improvement, HEDIS, NCQA, Data Analysis, Value-Based Care.
Job Summary Provides support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes. Uses a consultative approach, emphasizing physician engagement and behavior change through actionable data and analytics.
Company: Molina Healthcare
Location: United States
Salary: $52.199k - $101.788k
Job type: full-time. Experience level: mid.
Skills: Provider Engagement, HEDIS, Risk Adjustment, Quality Improvement, Data Analysis, Value-Based Care.
Job Summary Provides support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes. Uses a consultative approach, emphasizing physician engagement and behavior change through actionable data and analytics.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: staff.
Skills: Data Science, Healthcare Analytics, Hadoop, Power BI, R, Python.
Job Summary Lead data science and analytics initiatives to drive strategic decision-making and operational efficiency. Oversee the development and implementation of data models, ensuring data integrity and accuracy.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: staff.
Skills: Data Science, Healthcare Analytics, Hadoop, Power BI, R, Python.
Job Summary Lead data science and analytics initiatives to drive strategic decision-making and operational efficiency. Oversee the development and implementation of data models, ensuring data integrity and accuracy.
Company: Molina Healthcare
Location: United States
Salary: $83.252k - $128.519k
Job type: full-time. Experience level: mid.
Skills: Financial Analysis, Data mining, Statistical Analysis, SQL, Excel, VLOOKUP.
Job Summary Provides analyst support for financial analysis activities including data/text mining, analysis, modeling, and predicting to understand business issues, develop solutions and enable informed business decisions.
Company: Molina Healthcare
Location: United States
Salary: $83.252k - $128.519k
Job type: full-time. Experience level: mid.
Skills: Financial Analysis, Data mining, Statistical Analysis, SQL, Excel, VLOOKUP.
Job Summary Provides analyst support for financial analysis activities including data/text mining, analysis, modeling, and predicting to understand business issues, develop solutions and enable informed business decisions.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: senior.
Skills: Medicaid Risk Adjustment, Actuarial Modeling, Predictive Analytics, Financial Projections, Team Leadership, Data Analysis.
Job Summary Leads and manages team responsible for subject matter expertise in Medicaid risk adjustment in multiple states. Activities include extracting, analyzing, and synthesizing data from various sources to identify risks and opportunities; also supports analysis and reporting to operational…
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Case management, Care coordination, documentation, Customer Service, Time Management, Microsoft Office.
Job Summary Job Summary TMG is on the lookout for our next great Eligibility Screener! If you love doing meaningful work that helps others live their best lives, we want to hear from you!
Company: Molina Healthcare
Location: United States
Salary: $66.456k - $129.59k
Job type: full-time. Experience level: senior.
Skills: Care Management, Utilization Management, Behavioral Health, Care Transitions, Staff Supervision, Conflict Management.
***Remote and must live in Wisconsin*** 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…
Company: Molina Healthcare
Location: United States
Salary: $66.456k - $129.59k
Job type: full-time. Experience level: senior.
Skills: Care Management, Utilization Management, Behavioral Health, Care Transitions, Staff Supervision, Conflict Management.
***Remote and must live in Wisconsin*** 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…
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Data Management, Data Analysis, Compliance Monitoring, SharePoint, PowerBI, Microsoft Excel.
Job Summary Provides analyst support for delegation oversight activities including monitoring delegation oversight to ensure compliance with state, federal, National Committee for Quality Assurance (NCQA), and Molina requirements.
Company: Molina Healthcare
Location: United States
Salary: $101.721k - $198.356k
Job type: full-time. Experience level: senior.
Skills: Azure, Cloud Security, Network Security, Security Architecture, Identity Security, Risk Assessment.
Job Summary The Senior Security Architect will be a key leader in designing, evaluating, and enforcing security controls across our enterprise cloud and network environments.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: senior.
Skills: Healthcare Analytics, Data Stewardship, SQL, Data Modeling, Requirements Gathering, Data Validation.
Job Summary The Lead Analyst serves as a data steward with deep subject matter expertise, responsible for designing and prototyping Medical Economics data assets that are clearly defined and fit for use. This role bridges business and data by translating complex concepts into structured logic.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Customer Service, Call Center Operations, Problem Resolution, Data Processing, Time Management, Communication Skills.
Job Summary Provides level III support center customer service excellence to meet the needs of Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: senior.
Skills: Sarbanes-Oxley (SOX), Internal Audit, Risk Assessment, Internal Controls, Project Management, Financial reporting.
Job Summary Leads and manages team responsible for risk-based process design initiatives - leveraging a depth of internal audit, Sarbanes-Oxley (SOX), information technology and/or business experience to interpret significance of assessment findings, identify process improvement opportunities,…
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Internal Audit, Risk Assessment, Project Management, Financial reporting, Sarbanes-Oxley (SOX), Business Process Assessment.
Job Summary Provides senior level analyst support for risk-based process design initiatives - leveraging a depth of internal audit, Sarbanes-Oxley (SOX), information technology and/or business experience to interpret significance of assessment findings, identify process improvement opportunities,…
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: staff.
Skills: Leadership, Medicare, Medicaid, Health care operations, Health care administration, Provider services.
Job Summary Leads and directs team responsible for the development and administration of state health plan operational functions, programs and services - ensuring functional operations, contractual compliance, and alignment with health plan member satisfaction, retention, quality, and financial…
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: senior.
Skills: Customer Service, Call center management, Leadership, Team Development, Conflict Resolution, Insurance Knowledge.
Job Summary Leads and supervises team responsible for provision of support center customer service excellence to meet the needs of Molina members and providers. Ensures issues and needs are addressed fairly and effectively, and in alignment with Molina values.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Care Management, Managed Care, HEDIS Measures, Quality Improvement, Compliance, Data Extraction.
Opportunity for an experienced health care professional with at least 4 years of healthcare experience and at least 2 years of experience working in Care Management within a Manage Care Organization (MCO) to join our Medicaid/Medicare care management team.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Medical Coding, Medical billing, Regulatory Compliance, Policy Analysis, Data Analysis, Problem Solving.
Job Summary Responsible for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: entry.
Skills: advocacy, Resource Navigation, Member Engagement, Appointment Scheduling, Transportation Arrangement, Health Care Needs Management.
Job Summary Provides support for community-based member advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing health care needs.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Project Management, Program Management, Data Collection, Performance Measurement, Reporting, Continuous Improvement.
Job Summary The Sr Specialist, Member & Community Interventions oversees and implements new and existing clinical quality member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid).
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Financial Analysis, Reporting, Forecasting, Modeling, Trending, Financial Regulation.
Job Summary Provides senior level analyst support for finance activities including financial analysis, reporting, forecasting, trending and modeling to support planning for future business decisions such as new product development, marketing strategies and investments.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Data Extraction, Quality Improvement, Compliance Reporting, Communication, Deadline Management, Microsoft Office Suite.
Opportunity for an experienced health care professional with at least 4 years of healthcare experience and at least 2 years of experience working in Care Management within a Manage Care Organization (MCO) to join our Medicaid/Medicare care management team.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Evidence-Based Criteria, Medical Necessity, Regulatory Compliance, Clinical decision making, Behavioral Health, Utilization Reviews.
Job Summary Performs behavioral health utilization reviews, applying evidence-based criteria, and collaborating with physicians to ensure clinically appropriate, cost-effective, and regulatory-compliant care determinations.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: entry.
Skills: provider relations, Network Development, provider training, issue resolution, Customer Service, Policy Compliance.
Job Summary Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Care coordination, Case management, Community Health, Behavioral Health, Care Planning, EMR.
Job Summary Provides support for delivering integrated, whole-person care coordination to members engaged through community-based mobile services. Responsible for independently assessing and triaging member needs, creating real-time member care plans, addressing barriers to care, coordinating…
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Case management, Communication, documentation, Registered Nurse Licensure, Care Transition, Hospital Discharge Planning.
Job Summary The Transition of Care Coach (RN) provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from hospital admission to all other settings.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: entry.
Skills: Data Analysis, Reporting, Medicaid Risk Adjustment, Risk Adjustment Model, Risk Scores, Financial Impact Analysis.
Job Summary Responsible for being the SME (Subject Matter Expert) for Medicaid risk adjustment programs in multiple states. Maintain risk adjustment model, estimate risk scores, and analyze impact. Extract, analyze, and synthesize data from various sources to identify risks.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: entry.
Skills: Customer Service, Data Collection, Outreach, Audit support, Project Management, Coordination.
Must be able to work PST Hours JOB DESCRIPTION Job SummaryProvides support for medical records collection activities. Supports quality improvement activities through outreach to providers for collection of medical records for Healthcare Effectiveness Data and Information Set (HEDIS) specific data…
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Care Management, Care coordination, Motivational Interviewing, Long-Term Services And Supports, Multidisciplinary Team, Member Assessments.
This is a remote field-based role requiring travel. Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members…
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: senior.
Skills: Risk Adjustment, Quality Improvement, Data Collection, HEDIS, HOS, CAHPS.
Job Summary The Director, Quality & Risk Adjustment is responsible for leading health plan execution for Risk and Quality ensuring alignment of strategy and activities with Enterprise and acting as the Risk and Quality subject matter expert for the health plan.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: mid.
Skills: Medicare, Product Management, Product Development, Project Management, CMS regulations, Bids Filing.
Molina Healthcare is hiring a Lead, Medicare Administration. This will be a remote position on our team that is responsible for our Medicare product- both Bids and Member Materials.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: lead.
Skills: Strategic Planning, Leadership, Project Management, Risk Management, Contract Negotiation, Communication.
Job Summary Leads and directs team responsible for value-based programs (VBP) activities. Responsible for developing and implementing value-based strategies for lines of business impacted by the regulatory risk adjustment payment model.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: lead.
Skills: Network Development, Communication, provider relations, provider training, satisfaction, issue intake.
Job Summary Leads and directs team responsible for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network.
Company: Molina Healthcare
Location: United States
Job type: full-time. Experience level: senior.
Skills: Auditing, Compliance, CMS, NCQA, InterQual, MCG.
Job Summary Provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and…
We're analyzing Molina Healthcare's remote work culture to provide detailed insights.
Job Summary Provides subject matter expertise in the delivery, execution and maintenance of products. Accountable for maximizing the value of assigned technical products that support enterprise operations.
Molina Healthcare of Nebraska is hiring for a Senior Analyst, Provider and Claim Data & Analytics. This role is remote for those within the United States. Highly Qualified Candidates Will Have the Following Experience- • Medicaid and managed care • Claims and coding experience.
Job Summary Provides subject matter expertise in the delivery, execution and maintenance of products. Accountable for maximizing the value of assigned technical products that support enterprise operations.
Job Summary Provides senior level analyst support for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance.
Job Summary Provides senior level analyst support for data analysis and reporting activities. Responsible for organizing data from multiple sources to produce reports, dashboards, and analyses related to utilization, cost-containment, and business performance.
Job Summary Responsible for organizing data from multiple sources to produce reports, dashboards, and analyses related to utilization, cost-containment, and business performance.
Job Summary Provides analyst support for data analysis and reporting activities. This position is ideal for early-career analytical professionals seeking to build expertise in healthcare data analytics.
Job Summary Responsible for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance.
Job Summary Provides strategy and leadership to team responsible for enterprise project and portfolio management activities. Oversees project and portfolio management across mergers and acquisitions (M&A), growth, and other business initiatives - ensuring successful delivery of programs while…
Job Summary Provides strategy and leadership to team responsible for enterprise project and portfolio management activities. Oversees project and portfolio management across mergers and acquisitions (M&A), growth, and other business initiatives - ensuring successful delivery of programs while…
Job Summary Provides administrative level support to an Executive and division team members. Prioritizes management/client requests in order to meet business objectives. Supports the day-to-day administrative operations of the Executive and department.
Job Summary Provides subject matter expertise and leadership for health plan communications and marketing activities for the Nevada Health Plan. Responsible for developing internal and external brand aligned communications and marketing campaigns, including marketing and communications materials…
Job Summary Provides support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes. Uses a consultative approach, emphasizing physician engagement and behavior change through actionable data and analytics.
Job Summary Provides support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes. Uses a consultative approach, emphasizing physician engagement and behavior change through actionable data and analytics.
Job Summary Lead data science and analytics initiatives to drive strategic decision-making and operational efficiency. Oversee the development and implementation of data models, ensuring data integrity and accuracy.
Job Summary Lead data science and analytics initiatives to drive strategic decision-making and operational efficiency. Oversee the development and implementation of data models, ensuring data integrity and accuracy.
Job Summary Provides analyst support for financial analysis activities including data/text mining, analysis, modeling, and predicting to understand business issues, develop solutions and enable informed business decisions.
Job Summary Provides analyst support for financial analysis activities including data/text mining, analysis, modeling, and predicting to understand business issues, develop solutions and enable informed business decisions.
Job Summary Leads and manages team responsible for subject matter expertise in Medicaid risk adjustment in multiple states. Activities include extracting, analyzing, and synthesizing data from various sources to identify risks and opportunities; also supports analysis and reporting to operational…
Job Summary Job Summary TMG is on the lookout for our next great Eligibility Screener! If you love doing meaningful work that helps others live their best lives, we want to hear from you!
***Remote and must live in Wisconsin*** 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…
***Remote and must live in Wisconsin*** 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…
Job Summary Provides analyst support for delegation oversight activities including monitoring delegation oversight to ensure compliance with state, federal, National Committee for Quality Assurance (NCQA), and Molina requirements.
Job Summary The Senior Security Architect will be a key leader in designing, evaluating, and enforcing security controls across our enterprise cloud and network environments.
Job Summary The Lead Analyst serves as a data steward with deep subject matter expertise, responsible for designing and prototyping Medical Economics data assets that are clearly defined and fit for use. This role bridges business and data by translating complex concepts into structured logic.
Job Summary Provides level III support center customer service excellence to meet the needs of Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values.
Job Summary Leads and manages team responsible for risk-based process design initiatives - leveraging a depth of internal audit, Sarbanes-Oxley (SOX), information technology and/or business experience to interpret significance of assessment findings, identify process improvement opportunities,…
Job Summary Provides senior level analyst support for risk-based process design initiatives - leveraging a depth of internal audit, Sarbanes-Oxley (SOX), information technology and/or business experience to interpret significance of assessment findings, identify process improvement opportunities,…
Job Summary Leads and directs team responsible for the development and administration of state health plan operational functions, programs and services - ensuring functional operations, contractual compliance, and alignment with health plan member satisfaction, retention, quality, and financial…
Job Summary Leads and supervises team responsible for provision of support center customer service excellence to meet the needs of Molina members and providers. Ensures issues and needs are addressed fairly and effectively, and in alignment with Molina values.
Opportunity for an experienced health care professional with at least 4 years of healthcare experience and at least 2 years of experience working in Care Management within a Manage Care Organization (MCO) to join our Medicaid/Medicare care management team.
Job Summary Responsible for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance.
Job Summary Provides support for community-based member advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing health care needs.
Job Summary The Sr Specialist, Member & Community Interventions oversees and implements new and existing clinical quality member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid).
Job Summary Provides senior level analyst support for finance activities including financial analysis, reporting, forecasting, trending and modeling to support planning for future business decisions such as new product development, marketing strategies and investments.
Opportunity for an experienced health care professional with at least 4 years of healthcare experience and at least 2 years of experience working in Care Management within a Manage Care Organization (MCO) to join our Medicaid/Medicare care management team.
Job Summary Performs behavioral health utilization reviews, applying evidence-based criteria, and collaborating with physicians to ensure clinically appropriate, cost-effective, and regulatory-compliant care determinations.
Job Summary Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network.
Job Summary Provides support for delivering integrated, whole-person care coordination to members engaged through community-based mobile services. Responsible for independently assessing and triaging member needs, creating real-time member care plans, addressing barriers to care, coordinating…
Job Summary The Transition of Care Coach (RN) provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from hospital admission to all other settings.
Job Summary Responsible for being the SME (Subject Matter Expert) for Medicaid risk adjustment programs in multiple states. Maintain risk adjustment model, estimate risk scores, and analyze impact. Extract, analyze, and synthesize data from various sources to identify risks.
Must be able to work PST Hours JOB DESCRIPTION Job SummaryProvides support for medical records collection activities. Supports quality improvement activities through outreach to providers for collection of medical records for Healthcare Effectiveness Data and Information Set (HEDIS) specific data…
This is a remote field-based role requiring travel. Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members…
Job Summary The Director, Quality & Risk Adjustment is responsible for leading health plan execution for Risk and Quality ensuring alignment of strategy and activities with Enterprise and acting as the Risk and Quality subject matter expert for the health plan.
Molina Healthcare is hiring a Lead, Medicare Administration. This will be a remote position on our team that is responsible for our Medicare product- both Bids and Member Materials.
Job Summary Leads and directs team responsible for value-based programs (VBP) activities. Responsible for developing and implementing value-based strategies for lines of business impacted by the regulatory risk adjustment payment model.
Job Summary Leads and directs team responsible for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network.
Job Summary Provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and…
