Jobs at Molina Healthcare in Detroit, MI

19 job openings within 25 miles

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Director Claims - Managed Care Insurance

Molina Healthcare - Detroit, MI

Director Healthcare / Managed Care Claims Production Directs Healthcare / Managed care claim processes, productions, and inventories functions to accomplish timely, accurate, consistent, and cost-effective performance. Monitor claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Controls backlog...

Sr Analyst, Healthcare Analytics

Molina Healthcare - Detroit, MI

Job DescriptionJob SummaryPerforms research and analysis of complex healthcare claims data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.Knowledge/Skills/Abilities• Develop ad-hoc ...

Case Manager

Molina Healthcare - Detroit, MI

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, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress...

Supervisor, Care Management

Molina Healthcare - Detroit, MI

Job DescriptionJob Summary Molina Healthcare Services (HCS)[ ICA supports coordination servcies] works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS s...

Sr Specialist, Appeals & Grievances (Nurse)

Molina Healthcare - Troy, MI

Job DescriptionJob SummaryResponsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare an...

Sr Rep, Provider Services

Molina Healthcare - Troy, MI

Job DescriptionJob SummaryMolina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provi...

Community Connector

Molina Healthcare - Troy, MI

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, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress...

Case Manager (RN) Field Nurse: Oakland, Macomb, Genesee Counties

Molina Healthcare - Troy, MI

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, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress...

LTSS Care Coordinator

Molina Healthcare - Troy, MI

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, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress...

Nurse Practitioner (Remote: Oakland Cty, MI)

Molina Healthcare - Troy, MI

Job DescriptionJob SummaryCare Connections, a division of Molina Healthcare, seeks Nurse Practitioners to join its growing team which will contribute to the company mission to bring quality health care to the underserved. The Care Connections NPs focus on screening and preventive primary care services delivered in the home, community and nursing facili...

Coding Analyst

Molina Healthcare - Troy, MI

Job Description Job 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 fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the ...

Case Manager - Long Term Services & Support (RN/LMSW)

Molina Healthcare - Troy, MI

Job Description Job 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, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progre...

Transition of Care Coach

Molina Healthcare - Troy, MI

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, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress...

Supervisor, Provider Configuration Management

Molina Healthcare - Troy, MI

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. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to...

Analyst, Provider Configuration - Healthcare

Molina Healthcare - Troy, MI

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. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to...