Jobs at Molina Healthcare - Page 2

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Displaying results 16 - 30 of 351

Supv, Care Review Prior Authorization (Nurse)

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 ...

Care Review Processor

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...

Auditor, Compliance

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...

Sr Rep, Provider Services

Molina Healthcare - Midvale, UT

Job DescriptionJob SummaryMolina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Prov...

Applications Manager

Molina Healthcare - Long Beach, CA

Job Description Job summary: Responsible for end to end management of member enrollment process design, development and operations supportMentors and guides the team on end to end solutionRecommend software tools and development approaches that could benefit the department projectsEffectively communicates and collaborates with busines...

Applications Engineer

Molina Healthcare - Long Beach, CA

Job Description Job summary: Responsible for designing, developing, coding, unit testing, and debugging new software and producing significant enhancements to existing software. Conducts business process analysis, participates in design sessions with Architects in order to align information technology solutions with business initiatives. Applies and promotes key princip...

Senior Applications Engineer

Molina Healthcare - Long Beach, CA

Job Description Job summary: At least 5 + years of experience in Microsoft technologiesPerform BizTalk development and had extensive EDI transaction knowledge such as 837Perform .net and TSQL based development.Have good Knowledge of QNXT or FacetsTeam Player and Self Driven attitudeParticipate in architectural revi...

Case Manager (RN) Field Nursing Facility Cincinnati Area

Molina Healthcare - Columbus, OH

Job DescriptionOhio Plan Specific: Molina Healthcare of Ohio State Plan requires that this role be covered by a Registered Nurse. The purpose of the role is to visit the Molina Member in the Nursing Facility and sometimes the homes to facilitate Case Management for them. This is a field position in Cincinnati area. Although it is meant to be remote in nature, the first s...

Medical Dir, Health Plan Behavioral Health

Molina Healthcare - San Juan, Puerto Rico

Job DescriptionJob SummaryMolina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs.Knowledge/Skills/AbilitiesProvides medical oversight and ...

Examiner, Claims

Molina Healthcare - San Juan, Puerto Rico

Job DescriptionJob SummaryResponsible for administering claims payments, maintaining claim records. 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• Evaluates the adjudication of claims using standard principles and ...

Supv, Claims

Molina Healthcare - San Juan, Puerto Rico

Job DescriptionJob SummaryResponsible 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/Skil...

Complex Case Manager (RN)

Molina Healthcare - San Antonio, 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 toward desir...

Assoc Specialist, Appeals & Grievances

Molina Healthcare - Irving, TX

Job DescriptionJob SummaryMolina Healthcare's Appeals & Grievances jobs are 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 Medicaid.Knowledge/Skills/Abilities• Enters denia...

Specialist, Appeals & Grievances

Molina Healthcare - Irving, TX

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...

Care Review Processor

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...