Jobs at Molina Healthcare - Page 16

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Sr. Specialist, HEDIS/Quality Reporting

Molina Healthcare - San Antonio, TX

Job DescriptionJob Summary The Sr. Specialist, HEDIS/Quality Reporting,under the direction of the unit or program manager, will support the annual HEDIS project management by taking a lead role in coordinating the identification, collection and abstraction of medical records and other data in collaboration with other HEDIS staff. Molina's Quality Impro...

Sr.Specialist, HEDIS/Quality Reporting

Molina Healthcare - Laredo, TX

Job DescriptionJob Summary The Sr. Specialist, HEDIS/Quality Reporting,under the direction of the unit or program manager, will support the annual HEDIS project management by taking a lead role in coordinating the identification, collection and abstraction of medical records and other data in collaboration with other HEDIS staff. Molina's Quality Impr...

Analyst, Healthcare Analytics

Molina Healthcare - Doral, FL

Job DescriptionJob SummaryThe Analyst, Healthcare Analytics will perform 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 find...

Marketplace Lead, Call Center

Molina Healthcare - Albuquerque, NM

Job DescriptionJob SummaryProvides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions and complaints. Resolves member inquiries and complaints fairly and effectively. Provides product and service information to members, and identifies opportunities to maintain and increase member rela...

Provider Inquiry R&R Manager

Molina Healthcare - Long Beach, CA

Provider Inquiry Research & Resolution ManagerMolina Healthcare is seeking a Manager with claims, appeals, and dispute resolutions experience. Are you a leader? Are you ready for your next challenge? If so, then read on! Together we are a driven, well-trained, positive-minded workforce able to provide quality health care to those who ...

Sr 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...

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...

Marketplace, Member Rep I ( Call / Contact Center )

Molina Healthcare - Albuquerque, NM

Job DescriptionJob SummaryProvide new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions and complaints. Resolve member inquiries and complaints fairly and effectively. Provide product and service information to members, and identifies opportunities to maintain and increase member relatio...

Bilingual, Member Services Rep (Call /Contact Center )

Molina Healthcare - Columbus, OH

Job DescriptionJob SummaryProvides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions and complaints. Resolves member inquiries and complaints fairly and effectively. Provides product and service information to members, and identifies opportunities to maintain and increase member rela...

RN/SW Case Manager, LTSS field (Clark County)

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 ...

Case Manager, LTSS

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 ...

Rep, Provider Inquiry R&R (3 years of Claims Processing Experience)

Molina Healthcare - Oak Brook, IL

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.

Director Claims - Managed Care Insurance

Molina Healthcare - Detroit, MI

Director Healthcare / Managed Care Claims Production Directs Healthcare / Managed care claim processes, productions, and inventories functions to accomplish timely, accurate, consistent, and cost-effective performance. Monitor claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Controls backlog...

Lead Analyst, Healthcare Analytics

Molina Healthcare - Long Beach, CA

Job DescriptionJob 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.Knowledge/Skills/Abili...

Appeals & Grievance Coordinator

Molina Healthcare - Long Beach, CA

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 and Medicai...