JOB DESCRIPTIONJob SummaryResponsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Pla...
Job DescriptionJob OverviewThe Associate Vice President of Call Center Operations plays a critical role in managing and optimizing call center operations, with a focus on supporting Medicare-related services. As an......
JOB DESCRIPTIONJob SummaryResponsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Pla...
JOB DESCRIPTIONJob SummaryThe Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, community, and nursing facility settings. Provides needed care in the envir...
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JOB DESCRIPTIONJob SummaryResponsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operati...
JOB DESCRIPTIONJob SummaryThe Senior HRIS Analyst is responsible for technical operations of Oracle HCM Cloud system including data analysis and reporting, system administration, and project management. This role helps pr...
JOB DESCRIPTIONJob SummaryResponsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved market areas to achieve stated ...
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JOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, i...
Job SummaryAs a member of the Customer Experience team, the Director, Data Analytics ensures timely creation of key Executive and Health plan management reports, as well as providing critical analytical......
JOB DESCRIPTIONJob SummaryMolina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with im...
Job Description Job SummaryThe Social and Health Equity Navigator will assist members in addressing social conditions that impact health outcomes, assist with the development of a process to collect, analyze,......
For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. COMPACT......
Candidates must be able to work in PST hours 8-5pm M-F.JOB DESCRIPTIONJob SummaryMolina's HEDIS/Quality Improvement Medical Records Collector will work collaboratively in outreaching to providers in order to pursue medica...
Job Description Job SummaryResponsible for conducting various audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and concise to ensure accuracy in auditing......
Job DescriptionJob SummaryMolina Medicare Stars Program Manager functions oversees, plans and implements new and existing health care quality improvement initiatives and education programs. Responsible for Medicare Stars ...
JOB DESCRIPTIONJob Summary Responsible for accurate and timely production review of issues reported within our claims intake and processing ecosystem (QNXT, Edifecs, etc.). Gains understanding of solution functionality t...
JOB DESCRIPTIONJob SummaryAnalyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to loc...
JOB DESCRIPTIONJob SummaryFocuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, pla...
JOB DESCRIPTIONJob SummaryThe Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, community, and nursing facility settings. Provides needed care in the envir...
JOB DESCRIPTIONJob SummaryAnalyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to loc...
*** The candidate must be able to work PST hours.******The IT Sr. Systems Analyst is responsible for the analysis, design, and implementation of IT Healthcare Compliance & regulatory systems to......
JOB DESCRIPTIONJob SummaryMolina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the compan...
For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. COMPACT......
For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. COMPACT......
Job DescriptionJob SummaryMolina Healthcare of OH is seeking a Sr. Clinical Project Manager with experience in project management, business analysis, healthcare industry, and nursing work. The Clinical Sr. Project Manager...
KNOWLEDGE/SKILLS/ABILITIESDevelop and deploy workforce management strategies nationwide. Partner with leaders to identify business and propose solutions in line with the needs of our members and providers. Requires contac...
JOB DESCRIPTIONJob SummaryMolina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider communications, training and education, in alignment with...
JOB DESCRIPTION Job Summary Designs and implements processes and solutions associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business......
JOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, i...
JOB DESCRIPTIONJob SummaryFor this position we are seeking a Community Connector to provide support for the Medicaid population for the Michigan Health Plan. Excellent computer skills (Microsoft Office) and attention......
JOB DESCRIPTIONJob SummaryFocuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, pla...
JOB DESCRIPTIONJob SummaryCollects, validates, analyzes, and organizes data into meaningful reports for management decision making as well as designing, developing, testing, and deploying reports to other end users for op...
Molina Healthcare of Nebraska is hiring for a remote, Healthcare Government Contracts, Sr. Specialist. Preferred are candidates living within the state of Nebraska.The Sr. Specialist role will involve coordination of......
JOB DESCRIPTIONJob SummaryResponsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog an...
JOB DESCRIPTIONJob SummaryResponsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved market areas to achieve stated ...
JOB DESCRIPTIONJob SummaryResponsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved market areas to achieve stated ...
Job Description Job SummaryMolina Healthcare Services (HCS) Department works with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across th...
JOB DESCRIPTIONJob SummaryMolina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with im...
JOB DESCRIPTIONJob SummaryResponsible for the Management of internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process ...
JOB DESCRIPTIONJob SummaryAnalyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to loc...
Job DescriptionJob SummaryThe VP Value-Based Contracting is an executive focused on establishing and overseeing the organizations Value-Based Contracting Center of Excellence. The position acts as a strategic partner with...
JOB DESCRIPTIONJob SummaryResponsible for analysis of financial reports, trend, and opportunities. Includes evaluation of and recommendations relating to business opportunities, investments, financial regulations, and sim...
JOB DESCRIPTIONJob SummaryResponsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operati...
JOB DESCRIPTIONJob SummaryWorking closely with Molina enterprise Clinical Operations and Health Plan healthcare services leaders, and Medical Economics and Finance teams, drive, plan and manage a comprehensive program foc...
Job Description Job SummaryThe Sr Analyst, Risk Adjustment - Predicitve Analytics role supports Molina's Risk Adjustment Predictive Analytics team. Designs and develops Suspect, Targeting, and Tracking System to suport Mo...
Job SummaryThe Program Director, PMO (Business Integration) will support program activity related to integration of a single merger and acquisition or implementations to further Molinas growth, business success, and fisca...
JOB DESCRIPTIONJob SummaryThe Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care...
JOB DESCRIPTIONJob SummaryBecome a member of the Clinical Value Hub team as we guide the implementation of the Clinical Operations vision throughout the Molina enterprise. This position offers the opportunity......
JOB DESCRIPTIONJob SummaryAnalyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to loc...
Job DescriptionJob SummaryManages the activities of the Data Analytics and Reporting team. Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and......
JOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, i...
JOB DESCRIPTIONJob SummaryThe Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care...
For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. COMPACT......
JOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, i...
JOB TITLE : Manager, Healthcare ServicesThis position supports our NEVADA health plan. Nevada residents preferred. Applicants who do not live in Nevada will need to be licensed for Nevada and......
JOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, i...
JOB DESCRIPTIONJob SummaryProvides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.KNOWLEDGE/SKILLS/ABILITIES Performs on-...
Job DescriptionJob SummaryManages the activities of the Data Analytics and Reporting team. Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and......
Job Description Job SummaryMolina's Quality Improvement Sr. Abstractor conducts data collection and abstraction of medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The abstraction...
JOB DESCRIPTIONJob SummaryResponsible for conducting analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from vario...
JOB DESCRIPTIONJob SummaryThe Senior Analyst, Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for......
JOB DESCRIPTIONJob SummaryProvides general administrative support that includes routine document preparation, file management, scheduling/arranging meetings, arranging travel and ordering office supplies. May also perform...
Job DescriptionJob SummaryProvider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence...
JOB TITLE : Nurse (REGISTERED NURSE) Lead, Healthcare Services (Clinical)This position supports our NEVADA health plan. Nevada residents preferred. Applicants who do not live in Nevada will need to be......
JOB DESCRIPTIONJob SummaryPerforms research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healt...
JOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, i...
JOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, i...
JOB DESCRIPTIONJob SummaryThe Medical Assistant Care Connections will communicate with members after appointments and services to ensure that they are receiving quality care. They will function as a liaison to......
JOB DESCRIPTIONJob SummaryMolina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the compan...
Job DescriptionJob SummaryThe Solution Architect, Advanced Provider Data Management is responsible for understanding regulatory complexities, business challenges, and organizational strategy to develop new capabilities, o...
JOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, i...
JOB DESCRIPTIONJob SummaryDesigns and builds company specific enterprise application systems and technology expertise across multiple disciplines.Applies and promotes key principles (e.g., stability, scalability, performa...
JOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, i...
JOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, i...
Job Description Job SummaryResponsible for conducting various audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and concise to ensure accuracy in auditing......
For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. COMPACT......
JOB DESCRIPTIONJob SummaryMolina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for membe...
Job Description Job Summary Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource...
JOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, i...
JOB DESCRIPTIONJob SummaryResponsible for estimating liabilities, establishing premium rates, financial analysis and reporting. Extracts, analyzes, and synthesizes data from various sources to identify risks.KNOWLEDGE/SKI...
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