Job DescriptionReporting to the Director of Clinical Informatics for Analytics & Interfaces, the Clinical Informatics Data Analyst is responsible for the development, design, and maintenance of critical business repor...
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 SummaryThe role is responsible for establishing premium rates and conducting financial analysis and reporting. A key responsibility of this role is supporting the Molina Marketplace ACA individual prici...
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 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 position will be supporting the Kentucky and New Mexico Health plansResponsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Mai...
Job DescriptionJob SummaryThe Training Specialist is responsible for supporting various Training initatives. Utilizes strong organizational skills, project management skills, and experience facilitating in-person and virt...
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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 SummaryGeneral accounting tasks for tracking, processing, and payment of invoices for services or goods purchased from vendors. Responsibilities include ensures all disbursements are made under good fin...
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 SummaryAnalyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Assist with HTML, CSS and Javascript coding. Reviewing medical ...
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 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 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 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...
CARE REVIEW CLINICIAN INPATIENT REVIEW REGISTERED NURSE: KENTUCKY REMOTEFor this position we are seeking a Registered Nurse with previous Utilization Review / Utilization Management and knowledge of Interqual / MCG......
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 completionforcl...
Job DescriptionJob Summary*****This position will be focused on the Medicare STARS program. Please highlight your experience on your application. ******Designs and implements processes and solutions associated with a wide...
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 Lead Risk and Quality Performance Manager supports Molinas Risk & Quality Solutions (RQS) team by overseeing large programs and multiple projects supporting Molinas Risk Adjustment and Qu...
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 estimating liabilities, establishing premium rates, financial analysis and reporting. Extracts, analyzes, and synthesizes data from various sources to identify risks.KNOWLEDGE/SKI...
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 role is responsible for supporting the establishment of premium rates and conducting financial analysis and reporting. A key responsibility of this role is supporting the Molina Marketplace.....
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...
Molina Healthcare is hiring for a remote Pharmacy Operations SpecialistThis role can be worked remotely anywhere within the US.This role will be the primary contact for affiliated health plans, Pharmacy......
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 SummaryThe Cloud Database and Storage Engineer will be responsible for designing, implementing, and maintaining cloud-based database and storage solutions. This role involves ensuring the performance, availability, an...
***Remote and must live in Idaho***Job DescriptionJob SummaryMolina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance an...
JOB DESCRIPTIONJob SummaryProvides customer support and stellar service to meet the needs of our Molina members and providers.Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values 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 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 SummaryThis AVP, National Ancillary Contracting & Network Strategy will have direct responsibility over strategy and negotiations for DME, dialysis, lab, vision and transportation. Corporate Network...
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 ...
Molina Healthcare is Hiring For Medicare Pharmacy, Customer Service Reps!These roles are remote within the US, however you will be working MST (Mountain Standard Time) business hours.Preferred Availability is between......
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 SummaryRegional Director Risk & Quality Solutions is responsible for contributing to the strategic performance improvement direction and overseeing performance and execution for assigned regional st...
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 NCQA, CMS and State Medicaid requirem...
Job DescriptionJob SummaryThe AVP, Clinical Validation (PI) role within Payment Integrity utilizes clinical background andrelevant experience to lead the Clinical Operations team, consisting of clinical staff and certifie...
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 SummaryAVP, HP Engagement & Performance is responsible for contributing to the strategic planning and performance improvement direction for all markets assigned.Serves as a thought leader/partner to...
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 DESCRIPTIONFor this position we are seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/Utilization Review / Utilization Management and knowledge of Interqual / MCG......
This position is remote but working hours are M-F 6am-5pm PST.JOB DESCRIPTIONJob SummaryMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coo...
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 SummaryJob SummaryResponsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data am...
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 Summary The Dialer Administrator (DA) is responsible for administering day to day operations of the LCM dialer at our high-volume contact center. The DA is responsible for managing......
JOB DESCRIPTIONJob SummaryAnalyzes complex business problems and issues within Payment Integrity Pre-Pay using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trend...
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 developing the organization's short- and long-term financial plans and identifying financial opportunities to improve the organization's profitability. This position will support ...
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 Summary Provides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions and complaints. Resolves member inquiries and complaints fairly a...
For this position we are seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.......
Molina Healthcare is hiring for a remote Pharmacy Operations SpecialistThis role can be worked remotely anywhere within the US.This role will be the primary contact for affiliated health plans, Pharmacy......
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 SummaryThis role is on the Corporate Financial Planning and Analysis team primarily supporting G&A submissions. The successful candidate in this position will assist in the management of G&A......
Job DescriptionJob SummaryThe Sr. Analyst, Advanced Provider Data Management is responsible for analyzing and understanding business processes, identifying areas for improvement, and developing solutions to optimize perfo...
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 accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operati...
Job DescriptionJob SummaryMolina Risk & Quality Solutions (RQS) works with health plan risk & quality leaders to support implementation of best practices for optimal performance. The Program Director, RQS HP......
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 SummaryWe are looking for an adaptable actuary to assist in pricing Molina Marketplace ACA Individual Products. The right candidate should be comfortable working on a product with changing......
JOB DESCRIPTIONJob SummaryResponsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases...
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 SummaryThe Clinical Project Manager (PM) position plays a key role in various multi-functional projects, such as implementation of new programmatic changes, initiatives, or vended solutions; helping to ...
Job DescriptionJob Summary Troubleshoots hardware and software problems, assists users with desktop applications and provides user training. Utilizes applications such as Altiris to track user requests from trouble-ticket...
JOB DESCRIPTIONJob SummaryResponsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines, audit results, and federal regulations to determin...
JOB DESCRIPTIONJob SummaryAnalyst, Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and analysis to ensure access to quality healthcare services for people...
This job is 100% remote. Working hours are in PST M-F 8-5pm.JOB DESCRIPTIONJob SummaryResponsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure com...
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...
For this position we are seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.......
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......
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