Jobs at Molina Healthcare

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QA Auditor/Trainer

Molina Healthcare - Boise, ID

Knowledge/Skills/Abilities• Works with assigned managers, supervisors, or other team members to identify training needs.• Delivers training as applicable to assigned teams, including job specific training for new hires.• Stays abreast of changes in the organization and new requirements. Performs training as necessary.• Classifies quality audit criteria based upon cont...

Supv, Care Management

Molina Healthcare - Columbus, OH

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...

Nurse 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...

Nurse 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...

Sr. Finance Analyst - Medicare

Molina Healthcare - Bothell, WA

Job DescriptionJob SummaryThe Sr. Finance Analyst - Medicare will be responsible for analysis of financial reports, trend, and opportunities. Includes evaluation of and recommendations relating to business opportunities, investments, financial regulations, and similar financial projects or programs. Duties include gathering, interpreting, and evaluating financial info...

Sr. Finance Analyst

Molina Healthcare - Bothell, WA

Job DescriptionJob SummaryThe Sr. Finance Analyst will be responsible for analysis of financial reports, trend, and opportunities. Includes evaluation of and recommendations relating to business opportunities, investments, financial regulations, and similar financial projects or programs. Duties include gathering, interpreting, and evaluating financial information; ge...

Analyst, SURS Data

Molina Healthcare - Baton Rouge, LA

Job DescriptionJob SummaryPost payment review of Medicaid claims. Reviews claims utilizing records and system reports to determine proper documentation, utilization and appropriateness of services to identify possible fraud and abuse.Knowledge/Skills/Abilitieso Performs post payment analysis of claims and records.o Uses independent judgment ...

Clinical Appeals Nurse (RN)

Molina Healthcare - San Antonio, TX

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) performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request b...

Case Manager, LTSS (Dayton area)

Molina Healthcare - Cincinnati, OH

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...

Lead, Government Contracts

Molina Healthcare - Irving, TX

Job DescriptionJob SummaryResponsible for the strategic development and administration of contracts with State and/or Federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide health care services to low income, uninsured, and other populations.Knowledge/Skills/Abilities• Leads the day-to-day ove...

Mgr, Delegation Oversight

Molina Healthcare - Troy, MI

Job DescriptionJob SummaryResponsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with DMHC and DHCS requirements including delegation standards and requirements contained in the Molina Medical Compliance and Fraud, Waste and Abuse Program.Knowledge/Skills/A...

Case Manager

Molina Healthcare - Doral, FL

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...

Specialist, HEDIS/ Quality Reporting

Molina Healthcare - Bothell, WA

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...

AVP, Health Plan Quality Improvement

Molina Healthcare - Bothell, WA

Job DescriptionJob Summary The AVP, Health Plan Quality Improvement will serve as a leader of the health plan Quality strategy and activities, including but not limited to leadership and primary Molina interface with state agencies, leadership of local Quality committees and oversight of intervention activities intended to improve quality measures and ...

Care Review Clinician, Inpatient Review (RN)

Molina Healthcare - El Paso, TX

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 ...