Jobs at Molina Healthcare - Page 12

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Director, Provider Contracts

Molina Healthcare - Long Beach, CA

Summary Bring your Medical & Medicare contracting management experience to our California health plan. Lead the contracting group handling LA, Orange County & Inland Empire areas. What you will do:Plan, organize, staff, and coordinate the Provider Contracts activities for the state health plan. Work with direct management, senior leadership/management, Cor...

Medical Director, Health Plan

Molina Healthcare - Oak Brook, IL

Job Summary Bring your physician leadership and utilization review/management experience to our Medical Director role in the Illinois health plan. Solid performance in UM/UR arena may lead to project work in population health and affecting health outcomes for tens of thousands of members. What you will do:Provide medical oversight and expertise in ...

Adjuster, Claims Medicare and Healthcare

Molina Healthcare - Long Beach, CA

Claims Adjustments - knowledge of healthcare and managed care claims processes, review, correction. Medicare knowledge and experience a plus Job SummaryResponsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog ...

Director, Provider Contracts

Molina Healthcare - San Diego, CA

Summary Bring your Medical & Medicare contracting management experience to our California health plan. Lead the contracting group handling San Diego, Imperial Valley & Sacramento areas. What you will do: Plan, organize, staff, and coordinate the Provider Contracts activities for the state health plan. Work with direct management, senior leadership/...

Assoc Specialist, Provider Contracts

Molina Healthcare - Irving, TX

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, Healthcare

Molina Healthcare - Midvale, UT

Job Description Job SummaryPerforms 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.Molina Healthcare Core Com...

Sourcing Manager

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryResponsible for all aspects of purchasing goods and services required by the business, and collaborates with suppliers to determine price and purchasing schedule.Knowledge/Skills/Abilities• Collaborate with relevant businesses as a procurement partner to solidify Molina's competitive advantage• Develop d...

Sr Analyst, Data (SQL)

Molina Healthcare - Long Beach, CA

This position daily utilizes SQL Job SummaryDesigns and implements processes and solutions associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and u...

Provider Contracts Spc

Molina Healthcare - Albuquerque, NM

Job DescriptionJob SummaryProvides contracting expertise in the realm of providers.Knowledge/Skills/Abilities• Responsible for the negotiation of contracts and letters of agreements with hospitals, physician groups and ancillary providers that result in high quality, cost effective and marketable providers.• Initiates, negotiates...

Community Connector

Molina Healthcare - Spokane, 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 ...

Case Manager, Chemical Dependency Professional (Field: North Central Washington)

Molina Healthcare - Spokane, 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 ...

Sr Specialist, Appeals & Grievances (Nurse)

Molina Healthcare - Troy, MI

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 an...

Assoc Specialist, Provider Contracts

Molina Healthcare - Midvale, UT

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 ...

Supervisor, Provider Configuration Management

Molina Healthcare - Bothell, WA

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...

Certified Coder

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryProvides support to the business by making sure proper procedures are recorded accurately. Thus brings minimal risk to denials.Knowledge/Skills/Abilities• Primary resource for medical coding updates and information.• Provides advice on coding issues and researches procedures.• Reviews coding procedur...