Jobs at Molina Healthcare - Page 10

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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, HEDIS/ Quality Reporting

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryJob Summary In collaboration with Quality Improvement (QI) management, the Analyst, HEDIS/Quality Reporting develops and provides reports and cost-benefit analysis tools to meet QI requirements and uses automated software tools and processes to help streamline activities and improve data/analytics for the quality...

Analyst, Special Investigation Unit

Molina Healthcare - Long Beach, CA

Job DescriptionJob 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...

RN Case Manager Peds - Telephonic - Doral

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 ...

Senior Medical Director, Health Plan

Molina Healthcare - Columbus, OH

Job SummaryBring your physician leadership, UM and Medical Director experience and commitment to quality to our Ohio health plan. You will provide guidance to staff, be responsible for day-to-day operations of the Medical Affairs department, and represent the plan at state regulatory agency meetings.Responsibilities: • Assists in recruitment, hiring an...

RN Transition of Care Coach Patient Field Visits - Remote - Doral

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 ...

Claims Specialist, Provider Inquiry Research and Resolution

Molina Healthcare - Bothell, WA

Job DescriptionJob SummaryMolina Health Plan Operations jobs are responsible for the development and administration of our State health plan's operational departments, programs and services, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations.

Clinical Appeals Nurse (RN)

Molina Healthcare - Albuquerque, NM

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 up...

Director, Health Plan Pharmacy Services

Molina Healthcare - San Juan, Puerto Rico

Job DescriptionJob SummaryMolina Pharmacy Services/Management staff work to ensure that Molina members have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with ...

Analyst, Business

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryAnalyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Crea...

Sr Project Manager, PMO

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryFocuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, planning and issue/risk management.Knowledge/Skills/Abilities• Deep understanding of effective project approach(es) ...

Director, Compliance

Molina Healthcare - Long Beach, CA

Job SummaryBring your compliance management experience and managed care regulatory knowledge to our California health plan to lead the compliance program and help prevent and/or detect violation of applicable laws and regulations. You will ensure the health plan's accountability for compliance by overseeing and resolving investigations. What you will do:

Care Review Clinician, Inpatient Review (RN)

Molina Healthcare - Albuquerque, NM

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 ...

Community Connector(Jacksonville)

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 ...

RN Care Review Clinician, Inpatient Review - SNF Team - Remote

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...