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 leading strategic government affairs growth initiatives in states including positioning Molina Healthcare Inc. (MHI) with state officials. Identify and impact key public policy is...
JOB DESCRIPTIONCare Review Clinician, Inpatient Review- Behavioral HealthFor this position we are seeking a LPC or LCSW who lives in and must be licensed for the state they reside. Strong......
Job DescriptionJob Description****This job position will work EST business hours******Job SummaryThe Analyst, Encounters is responsible for monitoring inbound and outbound encounters processes and ensuring timely, accurat...
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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 SummaryField Travel in Webster, Kossuth, Humboldt and Cerro Gordo CountiesMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan an...
For this position we are seeking a California (RN) Registered Nurse with 3 years+ Concurrent Review/Utilization Review / Utilization Management and must have Interqual, and MCG guidelines experience. CURRENT RN......
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Job Description Job Summary Responsible for product development implementation and lifecycle management of Molina's health insurance marketplace products within assigned regions. Collaborate to obtain and synthesizing in...
JOB DESCRIPTIONJob SummaryMolina Pharmacy Services/Management staff work to ensure that Molina members, providers, and pharmacies have access to all medically necessary prescription drugs and those drugs are used in a......
JOB DESCRIPTIONJob SummaryThis position requires residence in the state of Nevada. Please only apply if you are open to relocation, or reside in the state of Nevada. Responsible for continuous......
Job DescriptionJob SummaryThis position is responsible for timely completion of Medicare and Medicaid applications for new and existing providers, reviewing, and verifying information for Care Connections providers for su...
JOB DESCRIPTIONJob SummaryResponsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the p...
Job DescriptionJob SummaryIdeal candidates would have large scale Medicaid and/or Medicare implementation experience.The Vice President, Enterprise Integration, will provide critical operational analysis, analytics and ac...
JOB DESCRIPTIONJob SummaryResponsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and State Medicaid requirem...
We are looking for a RN Care Transitions Case Manager who must reside in CALIFORNIA and be able to drive within one of the following county locations: Los Angeles County,......
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 SummaryThe VP, Mergers & Acquisitions leads the transaction sourcing and execution for Molina. This includes target pipeline development, due-diligence management, projection development, valuation, deal structuri...
JOB DESCRIPTIONJob SummaryMolina Pharmacy Services/Management staff work to ensure that Molina members have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner......
For this position we are seeking a California (RN) Registered Nurse with 3 years+ Concurrent Review/Utilization Review / Utilization Management and must have Interqual, and MCG guidelines experience. CURRENT RN......
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 DescriptionJob SummaryMolina Pharmacy Services/Management staff work to ensure that Molina members have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner......
JOB DESCRIPTIONJob SummaryThe Marketplace Business Analyst role will report to the Director of National Customer Experience, Marketplace Communications. This candidate will work cross-functionally to operationalize Market...
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 Description Job SummaryDesigns 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 decisions.......
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 serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the p...
JOB DESCRIPTIONJob SummaryMolina Pharmacy Services/Management staff work to ensure that Molina members, providers, and pharmacies have access to all medically necessary prescription drugs and those drugs are used in a......
JOB DESCRIPTIONJob SummaryDesigns 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 decisions. Gai...
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 SummaryAnalyzes and determines training needs and problems. Develops, administers, and implements all training programs in accordance with the Business' initiatives and strategies. Conducts special cour...
Job DescriptionJob SummaryResponsible for the development of marketing and sales collateral aimed at brand and message management. Develops, implements, and manages content for campaigns and other growth initiatives. Know...
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 Description Job Summary Architects company specific systems and technology expertise across multiple infrastructure and development disciplines. Applies and promotes key principles (e.g. stability, scalability, perfo...
Job Description Job Summary Architects company specific systems and technology expertise across multiple infrastructure and development disciplines. Applies and promotes key principles (e.g. stability, scalability, perfo...
The VP, Encounters is responsible for the Encounters function for all lines of business and reports to the SVP, Corporate Operations. This executive role leads and oversees all encounters operations......
JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSEFor this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review /......
JOB DESCRIPTIONJob SummaryThe Care Connections Representative primary focus is to conduct outbound calls to Molina members and schedule appointments with our Nurse Practitioners. As part of Molina's benefit package, the.....
Job DescriptionJob SummaryResponsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's member and enrollment records, employer's monthly reports, sending ...
JOB DESCRIPTIONJOB DESCRIPTIONWill be supporting enrollment data (and 834 EDI transactions). Ideal candidate will have experience working at an MCO supporting staff on enrollment issues, working with Finance to identifyin...
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 Senior HRIS Analyst is responsible for assisting with the day-to-day technical operations of UKG/Kronos Dimensions system including data analysis and reporting, system administration, and esc...
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 SummaryProvides general administrative support that includes routine document preparation, file management, scheduling/arranging meetings, arranging travel and ordering office supplies. May also perform...
For this position we are seeking a California (RN) Registered Nurse with 3 years+ Concurrent Review/Utilization Review / Utilization Management and must have Interqual, and MCG guidelines experience. CURRENT RN......
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 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 Description Job Summary Responsible for estimating liabilities, establishing premium rates, financial analysis and reporting. Extracts, analyzes, and synthesizes data from various sources to identify risks. Knowledg...
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 TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSEFor this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review /......
JOB DESCRIPTIONJob SummaryDo you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people......
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 SummaryFocuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, pla...
Job Description Job Summary Establish a specifically designed Operational Regulatory Oversight program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Busines...
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 Health Plan Operational Leadership roles provide overall direction and administration of the Plan's operational departments, programs, and services.Responsibilities include implementing pr...
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'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 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 SummaryThis role is not a IT-focused Security Operations (SOC) threat monitoring, incident identification and investigation activity. This role will support the overall cyber response program, which is ...
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 Summary Accurately record all calls in all Molina systems as applicable- CCA, QNXT, Database Responds to internal and external customers in a timely and accurate manner, treating......
JOB DESCRIPTIONJob SummaryMolina's HEDIS/Quality Improvement Medical Records Collector will work collaboratively in outreaching to providers in order to pursue medical records via phone call, fax, mail, electronic medical...
JOB DESCRIPTIONJob SummaryManages people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design pro...
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 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 SummaryThe Business Control Process Design and Implementation Senior, under the direction of Mgr, IT Controls and ERM, is responsible for developing a risk based process design approach for......
Job DescriptionJob SummaryMolina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance, and operational performance, in alig...
JOB DESCRIPTIONJob SummaryThe Member Navigator primary function is to be the member's liaison. Primarily telephonic, this role is responsible for ensuring that the members member has assistance they may need......
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 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 Description As the ManagerThird-Party Resilience (TPR),you will be a member of Molina HealthcaresThird-Party Resilienceteam, reporting to the Director. Third-Party Resilience provides a framework 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 SummaryResponsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the p...
Job DescriptionJob SummaryThe Director, Clinical Data Acquisition is responsible for the implementation, monitoring, and oversight of all chart collection for HEDIS, or HEDIS-like projects, Risk Adjustment, Risk Adjustmen...
For this position we are seeking a California (RN) Registered Nurse with 3 years+ Concurrent Review/Utilization Review / Utilization Management and must have Interqual, and MCG guidelines experience. CURRENT RN......
JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSEFor this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review /......
JOB DESCRIPTION Job Summary Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business fro...
JOB DESCRIPTIONFamily Care with My Choice WisconsinJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated deli...
JOB DESCRIPTIONJob SummaryThe ETL/BI developer will be responsible for the design and development of moderate to complex SSIS solutions. Additionally, this role will require the development of automated operational report...
JOB DESCRIPTIONJob SummaryJOB QUALIFICATIONSJob DescriptionWho you are : You have experience in QA and want to put RPA software to the test. You not only want to kick the tires......
JOB DESCRIPTIONJob SummaryMust be able to work in EST hours.Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims database...
JOB DESCRIPTIONFamily Care with My Choice WisconsinJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated deli...
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 Description Job Summary Responsible for the development of marketing or reimbursement approaches aimed at maximizing the sales opportunity. Develop product positioning strategy, product promotional approaches, reimbu...
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 preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's member and enrollment records, employer's monthly reports, sending ...
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 DESCRIPTIONFor this position, Enrollment experience is a must have. Ideal candidate will have experience working at an MCO onthe Enrollment operations team or at a health plan.Experience with 834......
JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW BEHAVIORAL HEALTH : REGISTERED NURSE (2 openings)For this position we are seeking a (RN) Registered Nurse with previous experience in Behavioral Health Acute......
Job Description Job Summary Molina's Quality Improvement Sr. Abstraction team functions to conduct data collection and abstraction of medical records for HEDIS projects, HEDIS like projects and supplemental data collecti...
Opportunity for a Telephonic RN to join our Marketplace Team performing telephonic Case Management. 100% remote. Schedule is M F, 8AM -5PM PST, and flexibility with schedule is necessary, as......
Job Description Job Summary Analyzes and determines training needs and problems. Develops, administers and implements all training programs in accordance with the Business' initiatives and strategies. Conducts special co...
Job Description Job Summary Under general supervision, this position has lead responsibilities for accessing, integrating, data compilation, data management, data analysis, data quality controls and reporting from variou...
Job Description Job Summary Directly responsible and accountable for performing chart reviews, physician education, and maintaining comprehensive knowledge of coding rules and regulations. Provide overall coding expertis...
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 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...
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