Jobs at Molina Healthcare - Page 10

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Dir, Process Improvement & Op Excellence

Molina Healthcare - Long Beach, CA

Leads business process improvement initiatives that result in operational efficiencies and/or an increase in customer satisfaction. Assists in development of MHI's business process improvement methodology and in the implementation of a business process improvement capability.Knowledge/Skills/Abilities• Defines program scope, establish approach for implementation and main...

Case Manager, RN or SW (North Sound)

Molina Healthcare - Bothell, WA

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...

Case Manager, RN (Sacramento, CA)

Molina Healthcare - Sacramento, 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 Analyst, Healthcare Analytics - Columbus, OH

Molina Healthcare - Columbus, OH

Performs research and analysis of complex healthcare claims data, pharmacy data, and lab 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.SQL knowledge and daily working with developing ad-hoc repo...

Prior Auth LPN Reviewer (MMS)

Molina Healthcare - Baton Rouge, LA

Job DescriptionJob SummaryResponsible for reviewing and resolving DME (Durable Medical Equipment) prior authorization requests. Reviews include initials and reconsiderations.Knowledge/Skills/Abilities• Accesses the ePA and automated prior authorization systems and the DHH criteria, assuring contractual requirements are accomplished by maintainin...

Sr. Abstractor, HEDIS/Quality Improvement (REMOTE)

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryMolina's Quality Improvement Sr. Abstraction team functions to conduct data collection and abstraction of medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The abstraction team will meet chart abstraction productivity standards as well as minimum over read standards.What you will be doing...

Adjuster, Claims

Molina Healthcare - Long Beach, CA

Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.Knowledge/Skills/Abilities• Researches tracers, adjustment...

.NET Software Engineer

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryUnder general direction, develops software and modification enhancements to a MMIS through all phases of a system lifecycle. Contributes to the company's success through excellent customer service and meeting or exceeding performance objectives.Knowledge/Skills/Abilities• Builds and maintains major business programming ...

Sr Analyst, HEDIS/Quality Reporting

Molina Healthcare - Columbus, OH

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...

Manager, Public Relations (Bi-Lingual)

Molina Healthcare - Long Beach, CA

Plans and conducts public relations and goodwill programs to improve relations with the public, industry, stockholders, and employees. Plans, prepares, and disseminates information utilizing media. May participate in advertising campaigns, edit material for publications, may manage local press releases and conduct public opinion polls. May include Corporate Giving and/or Corporate Contribut...

Assoc Specialist, Public Relat

Molina Healthcare - Long Beach, CA

Plans and conducts public relations and goodwill programs to improve relations with the public, industry, stockholders, and employees. Plans, prepares, and disseminates information utilizing media. May participate in advertising campaigns, edit material for publications, may manage local press releases and conduct public opinion polls. May include Corporate Giving and/or Corporate Contribut...

Registered Nurse Medicaid Enrollment

Molina Healthcare - Columbus, OH

Job DescriptionState of Ohio specific: The candidate for this role must be a Registered Nurse. That is a contractual obligation with the State of Ohio. How would you like to be the first contact with the member? We need someone who cares about the under-served. We need someone who wants to escort our members to better health. You would be their first point of contact. After you ...

Case Management Processor

Molina Healthcare - Midvale, UT

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...

Care Review Clinician (LPN/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...

Case Manager (RN) FIELD REMOTE

Molina Healthcare - Syracuse, NY

Job DescriptionThe State of New York Contract requires that this role be filled with a Registered Nurse with an unrestricted license in the state of New York. Remote for this role means field based or community based. Once a month meeting in office minimum. Rest of time is member visits at provider offices and/or home and documentation at home. Ratio of time...