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

102 job openings within 25 miles

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Nurse Practitioner:Remote*(Syracuse, NY)

Molina Healthcare - Long Beach, CA

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 facility settings....

Lead Generalist, Medicare Administration

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryResponsible for the management of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic ...

VP, Encounters

Molina Healthcare - Long Beach, CA

Knowledge/Skills/AbilitiesThe Encounters Vice President oversees and monitors claims & encounters processes, including partnering with cross-functional teams (Plan or MHI) to prevent encounter rejections via root cause analysis and resolution. • Monitors and/or assigns encounter workflow queues; ensures volume and aging are current. • Oversees researching of claim...

RN SIU Investigator

Molina Healthcare - Long Beach, CA

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 fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing revi...

Associate Specialist, Provider Contracts

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...

Manager, Provider Contracts

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...

Associate Representative, Provider Network Services - Support

Molina Healthcare - Long Beach, CA

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. Provider Services...

Associate Specialist, Provider Network Administration

Molina Healthcare - Long Beach, CA

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 to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts....

Delegation Oversight Nurse (LVN or RN)

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...

Nurse Practitioner: Remote *(Victorville/Adelanto/Hesperia, CA)

Molina Healthcare - Long Beach, CA

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 facility settings....

Senior Provider Contracts Specialist

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 house...

Medical Denial Review Nurse

Molina Healthcare - Long Beach, CA

Review (audit) medical necessity denial language for Medicare inpatient claims;Review Medicare claim appeal overturns to determine root cause and possible remediationLiaison between Claims and Health Plans and (MCR) on denial questions, review, language, and suchReview denials for services other than inpatient stays, such as DME, home health, etc

Analyst, HEDIS/ Quality Reporting

Molina Healthcare - Long Beach, CA

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 members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities...

Member Health Assessor, LVN

Molina Healthcare - Long Beach, CA

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 toward desir...