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...
Molina Healthcare of Nevada is seeking a dynamic Community Outreach, Growth & Engagement Specialist in/near the Clark County area.This role will help drive choice membership and retain existing members. This......
JOB TITLE: CARE REVIEW CLINICIAN PRIOR AUTHORIZATION LPN/ LVNSPECIALIST IN PEDIATRICS CLINICAL UTILIZATION MANAGEMENT REVIEWSThis position supports our AUDIT team and UM processes. Experience with MS Excel is a must.For.....
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Job DescriptionJob SummaryThe role, reporting directly to the Head of Strategy, is a critical member of the Strategy team, which supports senior executives in creating corporate, business unit, and local......
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 SummaryFocuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, pla...
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JOB DESCRIPTIONJob SummaryProvides 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...
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...
***The candidates must reside in CA*****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......
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...
***Remote and must live in Michigan***Job DescriptionJob SummaryMolina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignmen...
Director, Sales & RetentionWork Location: New York City, NYThe Director Sales and Retention will be directly involved in the development, oversight, and support of strategic and tactical statewide growth initiatives.....
Job DescriptionJob SummaryDevelops clinical policies to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the......
JOB DESCRIPTIONJob SummaryProvides 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...
***Candidates For This Position Must Reside in/near Salt Lake County, Utah ***Are you passionate about serving others? Do you have established relationships within the community?Come join our growingGrowth ...
JOB DESCRIPTIONJob SummaryTMG by Molina Healthcare is seeking a remote IRIS Consultant Supervisor for Milwaukee County.IRIS Consultant Supervisors provide leadership management and supervision to a team of IRIS Consultant...
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...
NIGHT SHIFT WORK SCHEDULE:EMERGENCY ROOM ADMISSIONS REVIEW NURSEPERMANENT SHIFT WILL BE A 12 hour NIGHT SHIFT:7:30PM (in the evening) - 08:30AM (in the morning) PACIFIC HOURS , 3 days a......
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 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 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 The SIU Senior Investigator position is primarily responsible for supporting the day to day operations and initiatives of the Special Investigations Unit (SIU). Knowledge/Skills/Abilities R...
JOB DESCRIPTIONFor this position we are seeking a (RN) Registered Nurse who lives in VIRGINIA and must be licensed for the state of VIRGINIA.Case Manager will work in remote 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 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 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 SummaryEnsures the health plan meets its Community Reinvestment obligations under the Medicaid and HIDE SNP contracts while supporting the needs of the communities served across its footprint. Leads......
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, Encounters is responsible for monitoring inbound and outbound encounters processes and ensuring timely, accurate, and complete encounter submissions for low- to moderate-complexity m...
*** 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 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 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 ...
KNOWLEDGE/SKILLS/ABILITIESOversees an auditing team responsible monthly auditing of HCS staff Functions as a hands-on supervisor, providing direction and guidance to the auditing team to ensure implementation of activitie...
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 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, ...
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 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......
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......
We are seeking a NURSE OR SOCIAL WORK CASE MANAGER who must live in the state of ILLINOIS. TRAVELwithin SOUTH COOK COUNTY will be required. Excellent computer skills and attention......
JOB DESCRIPTIONFor this position we are seeking a (RN) Registered Nurse who must be licensed for the state they reside in. Strong medical and hospital analytical experience is needed. Excellent......
KNOWLEDGE/SKILLS/ABILITIES Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Dise...
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, ...
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 DESCRIPTIONFor this position we are seeking a (RN) Registered Nurse who lives in VIRGINIA and must be licensed for the state of VIRGINIA.Case Manager will work in remote and......
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 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...
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 DescriptionJob SummaryWorks with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. Assesses members for care needs, and develops......
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 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 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 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 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...
*Candidate must live in Kentucky for this work from home opportunityJOB DESCRIPTIONJob SummaryProvides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues......
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 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 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 SummaryProvides 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...
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 ...
Bilingual Required: Mandarin, Cantonese, Vietnamese, Tagalog, Korean or French Shift: 7:30 am 4pm PST= 8:30 am 5:00pm MST = 9:30am 6:00pm CST= 10:30am 7:00pmEST Required License: Active and unrestricted Life......
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......
We are seeking a Social Work or Registered Nurse CASE MANAGERS for our ILLINOIS Health Plan. Candidates must live in BUREAU COUNTY in the state of ILLINOIS for consideration.Case Managers......
Opportunity for a BILINGUAL SPANISH 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......
Charlottesville, Virginia
1 day
JOB DESCRIPTIONFor this position we are seeking a RNwho lives in VIRGINIA and must be licensed for the state of VIRGINIA. We are looking for candidates who live in the......
Black River Falls, Wisconsin
1 day
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...
***Remote and must live in Michigan***Job DescriptionJob SummaryMolina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance...
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...
For this position we are seeking a (RN) Registered Nurse who lives in VIRGINIA and must be licensed for the state of VIRGINIA.Clinical Auditor RN will support our Virginia Healthcare......
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 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 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 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, 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, ...
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 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 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 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/ABILITIES Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Dise...
*Candidate must be Bilingual (Spanish) and have high volume Outbound Call Center experience.JOB DESCRIPTIONJob SummaryProvides customer support and stellar service to meet the needs of our Molina members and providers.......
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 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 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 Molina 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 SummaryThe Clinical Correspondence Review Nurse is responsible for performing quality reviews of written clinical determination letters to members and providers to ensure clinical determination letters ...
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 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 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...
***Remote and must live in New York***Job DescriptionJob SummaryMolina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignmen...
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