Jobs at Molina Healthcare in Long Beach, CA - Page 2

103 job openings within 25 miles

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Director, Healthcare Fraud Waste Abuse Vendor Oversight Ops

Molina Healthcare - Long Beach, CA

1) Critical requirements are: (1) Experience in an Special Investigations Unit (SUI) unit in healthcare, (2) Knowledge of MCO, market place, medicaid and medicare billing, (3) prior experience with complex systems and workflows, (4) development of quality assurance measures and trackingActs as liaison be...

Sales - Account Representative, Medicare (Imperial County, CA)

Molina Healthcare - Long Beach, CA

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 revenue, profitability and retention goals, while following ethical sales practices and adhering to established policies and procedures.

Specialist, Appeals & Grievance

Molina Healthcare - Long Beach, CA

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 and Medicaid

Delegation Oversight Nurse (RN or LVN)

Molina Healthcare - Long Beach, CA

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 requirements including delegation standards and requirements contained in the delegation agreement.Knowledge/Skills/AbilitiesThe Deleg...

Project Coordinator, Provider Network Administration

Molina Healthcare - Long Beach, CA

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 be housed on...

Financial & Pricing Analyst

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryResponsible for supporting and validating Provider Network contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting. Perform financial modeling to support well-informed negotiations, anticipating issues resulting in the ability to reach contract terms with good faith with sustaina...

Analyst, Reporting & Analytics

Molina Healthcare - Long Beach, CA

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 other end users for operational and strategic analysis.Knowledge/Skills/Abilities• Performs research and analyses on a variety ...

Executive Compensation Consultant (In-House)

Molina Healthcare - Long Beach, CA

Job DescriptionJob Summary The Executive Compensation Consultant will drive activities across all key areas of executive compensation including: The design and implementation of executive compensation programs for Molina Healthcare's executive population Preparation of the annual proxy statement Creation of presentations and a...

Program Manager

Molina Healthcare - Long Beach, CA

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 process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and ...

Manager, Risk Adjustment - Medicare

Molina Healthcare - Long Beach, CA

The Manager Risk Adjustment Data Operations is responsible for the timely and accurate collection, flow and processing of data for risk adjustment, including Medicare, MMP and Marketplace. The Manager will establish, monitor, and maintain the processes, IT systems and services that collect and process the data from claims, encounters, electronic medical records, medical record co...

National Benefit Advisor (Life/Health Licensed)

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryTelesales role. Responsible for taking and making telephone calls with prospective members with the intent to educate them on benefits of Molina products and then conducts enrollment into product of choice over the phone or other sales enrollment channel desired.Knowledge/Skills/Abilities• Strong working knowledge of Me...

Outreach Rep, Member Services (Long Beach, CA)

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryProvides new and existing members with the best possible service in relation to service request and scheduling of quality visits by clinical staff in patient/member place of residence. This Member Outreach is an imperative aspect of our Quality Management of the Chronically Ill Patient. Provides service information to members...

Sr Analyst, Config Info Mgmt - QNXT Claims

Molina Healthcare - Long Beach, CA

QNXT claims system experience Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to bus...

Project Coordinator

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryThe Project Coordinator will provide general administrative support that includes routine document preparation, file management, scheduling/arranging meetings, arranging travel and ordering office supplies. May also perform a variety of activities in support of the functional processes, programs and/or services. Also provides the administ...

Executive Assistant

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryProvides administrative level support to management and/or division team members. Prioritizes management/client requests in order to meet business objectives. Supports the day-to-day administrative operations of a department and/or site.Knowledge/Skills/Abilities• Composes and types routine memos and corresp...