Job DescriptionJob SummaryResponsible for overseeing data science projects, managing and mentoring a team, and aligning data initiatives with business goals. Lead the development and implementation of data models, collabo...
JOB DESCRIPTIONJob SummaryResponsible for managing and overseeing KPI and SLA reporting for the department, ensuring accuracy, timeliness, and quality in delivery and synergy across reporting platforms. Briefs executives ...
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 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...
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Knowledge/Skills/Abilities Responsible for program development, implementation, and management of process improvement initiatives. Coordinates, directs, and manages the activities of the department and the process improve...
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 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...
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Job DescriptionJob SummaryThe Director of Data Governance will build and execute the enterprise data governance strategy and roadmap in alignment with the company's vision. This role is within the company's......
JOB DESCRIPTIONJob SummaryUnder supervision, applies software engineering methods and techniques to the design, development, integration, qualification and/or support of Microsoft Reporting Services, SQL stored procedures...
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...
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 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 Summary As the Manager, Workforce Risk, you will be a member of Molina Healthcares Protection Services Operations Center, reporting to the AVP. This role will be responsible for......
Job DescriptionJob SummaryFocuses on the alignment of strategic goals and organization objectives to the business project portfolio. Provides direct input into the governance cycle that supports the achievement of key......
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 Regional Manager Value Based Programs plays a critical role in the implementation of value-based programs and contracts by supporting both the local markets and national value based......
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 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 SummaryCollects, validates, analyzes, and organizes data into meaningful reports for management decision making as well as designing, developing, testing and deploying reports to provider networks and o...
Job DescriptionJob SummaryMolina MTM Pharmacy Services staff work to ensure that Molina members have access to Medicare Star medications and those meds are used in a cost-effective, safe manner. These......
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 Principal Proposal Writer is responsible for directly supporting the development of compelling content and sections of proposals for government sponsored managed care programs or health care ...
Job DescriptionJob SummaryThe Sr Proposal Writer is responsible for creating, revising, and editing proposal content that supports Molinas response to Requests for Proposal (RFP). Will continuously strive to increase know...
JOB DESCRIPTIONJob SummaryManages a team of professional Configuration Analysts. Responsible for operational activities for the assigned team, including accurate and timely implementation and maintenance of critical infor...
JOB DESCRIPTIONJob SummaryThe AVP, Compliance is responsible for oversight and management of health plan or product compliance activities and serves as a resource on compliance issues. Provides leadership and expertise......
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 Preferred Bilingual: Spanish, Vietnamese, Cantonese, Mandarin, Tagalog and French Required License: Active and unrestricted Life and Health Insurance LicenseJob SummaryTelesales role. Responsible for takin...
Job DescriptionJob SummaryMolina's HEDIS/Quality Improvement Sr. Medical Records Collector is a team member with several years experience in working collaboratively with outreaching to providers in order to pursue medical...
Job DescriptionJob SummaryThe Lead Analyst, Advanced Provider Data Management is responsible for analyzing and understanding business processes, identifying areas for improvement, and developing solutions to optimize perf...
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 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 SummaryManages people who are responsible for internal business projects and programs involving contact center department or cross-functional teams of subject matter experts, delivering products through...
Job DescriptionJob 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 Mol...
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 conducting analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extract, analyze, and synthesize data from various ...
Knowledge/Skills/AbilitiesActs as liaison between Special Investigations Unit (SIU) operations and contracted vendor(s) to assure a smooth workflow exists, quality assurance measures are designed and monitored, appropriat...
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 SummarySupports ongoing Claims and Enrollment operations in the management of smaller scale, less complex vendor activities. Provides daily operational support to the vendors. Monitors inventory levels,...
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 SummaryMolinas Quality Management function implements, oversees, and maintains new and existing healthcare quality monitoring activities and programs; ensures quality monitoring audits and investigation...
Job DescriptionJob SummaryThe Proposal Writer is responsible for creating, revising, and editing proposal content that supports Molinas response to Requests for Proposal (RFP). Supports the development of response-focused...
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 Design Manager is responsible for the development of graphic art and visual materials for proposal and non-proposal documents. Ensures the accuracy, quality, and timeliness of design elements...
JOB DESCRIPTIONJob SummaryClinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards.KNOWLEDGE/SKILLS/ABILITIES The Clinical Appeals Nurse (RN) 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 Medicare Stars Sr Program Manager function supports program governance, plans, leads and implements quality improvement initiatives and education programs to support improved Star Ratings....
This position requires an actively licensed Registered NurseJOB DESCRIPTIONJob SummaryThe mission of Clinical Operations is to drive value through an integrated Clinical Center of Excellence and to deliver value through.....
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 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 SummaryManages a process that blends standard actuarial modeling, medical economics, and financial reporting and analytics. Analyzes data for cost savings opportunities and performance improvement initi...
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 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 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 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 DESCRIPTIONJob SummaryAssist business teams with developing requirements for major projects of considerable complexity, prepares system design specifications, conducts research to resolve customer initiated issues rel...
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 Architects company specific systems and technology expertise across multiple infrastructure and development disciplines. Applies and promotes key principles (e.g. stability, scalability, perfor...
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 (Purpose of the Job & high-level summary):The Molina Healthcare Internship Program shares an objective to create a steppingstone for students who aim to be professionals and future......
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 SummaryAssist business teams with developing requirements for major projects of considerable complexity, prepares system design specifications, conducts research to resolve customer-initiated issues rel...
Job DescriptionJob SummaryWe are seeking an experienced and strategic Director of Financial Planning & Analysis to join our team. In this critical role, you will lead the planning, budgeting, and......
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 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......
This position is 100% remote. Working hours are M-F 7:30am-4:00pm must work PST hoursJob DescriptionJob SummaryResponsible for conducting various audits including, but not limited to; vendor, focal, audit the auditor.......
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 SummaryResponsible for Enrollment related internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process...
Job DescriptionJob SummaryActive collaborator providing bi-lateral support around the redlining; negotiating; formal execution of contractual obligations between outside party and Molina Healthcare. Serves as key role pla...
Job DescriptionJob Summary Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, pl...
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 consultative support and medical cost-based analysis of markets and network initiatives. The Medical Economics Consultant manages conflicting priorities and multiple projects concurrentl...
JOB DESCRIPTIONJob SummaryThis role will execute the enterprise data governance strategy and roadmap in alignment with the company's vision. This role is within the company's Enterprise Information Management (EIM) organi...
JOB DESCRIPTIONFor this position we are seeking a (RN) Registered Nurse who must have a current active unrestricted RN license in the state of OH (Compact Licensure)Case Manager RN will......
Job DescriptionJob SummaryMolinas Quality Management function implements, oversees, and maintains new and existing healthcare quality monitoring activities and programs; ensures quality monitoring audits and investigation...
Job DescriptionJob SummarySupport the Market CFO in Wisconsin FP&A. Performs research and analysis of complex healthcare claims data, and utilization management data for month-end reporting, ad-hoc requests, rate advo...
Job DescriptionJob SummaryThe Risk & Quality Performance Manager position will support Molinas Risk & Quality Solutions (RQS) team. This position collaborates with various departments and stakeholders within Molin...
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 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 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 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 SummaryMolina MTM Pharmacy Services staff work to ensure that Molina members have access to Medicare Star medications and those meds are used in a cost-effective, safe manner. These......
Job DescriptionJob Summary Responsible for collecting, storing, processing, and analyzing large sets of data. The primary focus will be on choosing optimal solutions to use for these purposes, then maintaining,......
Job DescriptionJob SummaryMolina Segment leaders are responsible for the development and administration of Segment specific departments, programs and services, in alignment with Molina Healthcare's overall mission, core v...
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 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 SummaryThe Lead Analyst, Advanced Provider Data Management is responsible for analyzing and understanding business processes, identifying areas for improvement, and developing solutions to optimize perf...
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 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 SummaryPerform data and error analysis to improve models, and clean and validate data for uniformity and accuracy. Execute data science and statistical analytical experiments methodically to help solve....
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 SummaryLead data science and analytics initiatives to drive strategic decision-making and operational efficiency. Oversee the development and implementation of data models, ensuring data integrity and a...
Job DescriptionJob 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 Business ...
JOB DESCRIPTIONFor this position we are seeking a (RN) Registered Nurse who must have a current active unrestricted RN license in the state of CA.Case Manager RN will work in......
This position is 100% remote. Working hours are M-F 7:30am-4:00pm must work PST hoursMust have Claims Examiner or Claims Adjustment exp and had process High dollar claims in Healthcare.Job DescriptionJob......
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