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 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 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 accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operati...
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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 SummaryThe SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses information from a tip, member benefits...
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JOB DESCRIPTIONJob SummaryThe Marketplace Facilitated Enroller (MFE) is responsible for identifying prospective members that do not have health insurance and assisting with the enrollment process ultimately making it easi...
JOB DESCRIPTIONJob SummaryServes as a leader of quality improvement compliance activities. Oversees national QI compliance activities that support the quality program for all lines of business across all health plans.......
Job DescriptionJob SummaryMolina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mis...
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 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 SummaryWe are seeking a highly skilled and adaptable actuary responsible for pricing Molina Marketplace ACA Individual Products. The ideal candidate will thrive in a space characterized by dynamic......
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 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 Description Job SummaryBusiness Strategy Leader managing relationships and providing process expertise with Molina health plan leadership, corporate leadership, business subject matter experts (SMEs), business and IT ...
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 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 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 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 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 SummaryThis position is a project management role focused on supporting provider data solution and processes. Contributing to accurate and timely maintenance of critical provider information on all clai...
Job DescriptionJob SummaryThe Program Director, Marketplace Contracting is responsible for managing the Marketplace provider contracting process for the assigned regions. Leads the Marketplaces provider strategy, while de...
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 continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with DMHC and DHCS requirements including ...
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 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 Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider communications, training and education, in alignment with...
Job DescriptionJob SummaryMolina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mis...
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...
KNOWLEDGE/SKILLS/ABILITIESDevelop and deploy workforce management strategies nationwide. Partner with leaders by strategically identifying business needs and propose solutions in line with the needs of our members and pro...
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 planning, developing, and directing the implementation of strategies to ensure high levels of performance and quality within the established quality improvement processes and prog...
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 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 retrospective risk adjustment programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plan...
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 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 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 DESCRIPTIONOpportunity for a US licensed RN to do prior authorization reviews with Molina Healthcare. Applicants call across the contiguous US states are eligible to apply but must be willing/able......
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 Manager, Business Development, Facilitated Enrollments, is responsible for for overseeing daily operations and driving individual and team performance. The Manager will lead a team of Facilit...
Job DescriptionJob SummaryResponsible for continuous quality improvements regarding member engagement and memberretention. Represents Member issues in areas involving member impact and engagement including:New Member Onbo...
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 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 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 analysis of financial reports, trend, and opportunities. Includes evaluation of and recommendations relating to business opportunities, investments, financial regulations, and sim...
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 SummaryFocuses on process improvement, organizational change management,collaboration with providers and Health Plans,project management and other processes relative to the business. Project management ...
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 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 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 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 SummaryThis role requires a strategic thinker with excellent project management skills, who can coordinate cross-functional teams and drive results in a fast-paced environment.Responsible for internal b...
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 SummaryThe Sr Video Producer manages and elevates the brand of all entities under the Molina Healthcare and the MolinaCares Accord name, providing the video production for all......
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, ...
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 Analyst, Clinical Policy reviews and evaluating existing clinical policies, proposes suggested improvements to existing clinical policies, and researches new policies. Creates reports and ana...
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 SummaryLead Systems Analyst, TCIM - Tech Support, Data Analytics, Emerging technologiesJob DescriptionThe Technical Systems Analyst will be responsible for the design and development of moderate to comp...
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 administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog an...
JOB DESCRIPTIONJob SummaryEstablish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraud...
JOB DESCRIPTIONJob SummaryUtilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, b...
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 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......
PRIOR AUTHORIZATIONS : REGISTERED NURSEFor this position we are seeking a (RN) Registered Nurse with previous experience in Prior Authorizations, Utilization Review / Utilization Management and knowledge of Interqual /......
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***** Candidate must be able to work during EST hours*****Job SummaryPerforms research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost......
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 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 the...
Job DescriptionJob SummaryThe AVP, Market Share is responsible for leading and implementing the strategy that drives improved market share through choice adds, auto-assignment, retention and redetermination. This includes...
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......
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