Jobs at Molina Healthcare - Page 5

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Claims Compliance Auditor

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 Health Care...

Sr 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. Creates specifica...

Financial & Pricing Analyst

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryResponsible for supporting and validating Provider Network contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting. Perform financial modeling to support well-informed negotiations, anticipating issues resulting in the ability to reach contract terms with good faith with sustaina...

Sr. Healthcare Analyst (Medicaid Encounters)

Molina Healthcare - Columbus, OH

Job Description Job SummaryPerforms research and analysis of medical, pharmacy and dental encounters. Evaluates, writes, and presents analyses and makes recommendations based on relevant findings.Knowledge/Skills/Abilities• Ensure beginning-to-end encounter process is compliant with federal and state requirements; provide and imple...

Program Manager

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryManages people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May...

Assoc Rep, Provider Services

Molina Healthcare - Houston, TX

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. Provider Services...

Case Manager, LTSS

Molina Healthcare - Troy, MI

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, Finance

Molina Healthcare - Doral, FL

Job DescriptionJob SummaryResponsible for analysis of financial reports, trend, and opportunities. Includes evaluation of and recommendations relating to business opportunities, investments, financial regulations, and similar financial projects or programs. Duties include gathering, interpreting, and evaluating financial information; generating forecasts and analy...

Sr Analyst, Finance

Molina Healthcare - Cayce, SC

Job DescriptionJob SummaryResponsible for analysis of financial reports, trend, and opportunities. Includes evaluation of and recommendations relating to business opportunities, investments, financial regulations, and similar financial projects or programs. Duties include gathering, interpreting, and evaluating financial information; generating forecasts and analy...

Business Analyst, Process Improvement - Corporate

Molina Healthcare - Long Beach, CA

Job DescriptionTypically researches and triages to resolution issue that are causing claims to pay incorrectly. Studies weekly/monthly trends of claims KPI indicators such as Interest, adjustments and rework and samples claims to understand and fix root causes of errors and excessive payments. Knowledge/Skills/Abilities Expert knowledge of claims proce...

Manager, Projects

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• Ability to manage multiple complex, challenging projects simultane...

Field Case Manager, RN or Social Worker (Tri-Cities, WA)

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 toward desir...

Provider Contracting Manager

Molina Healthcare - Bothell, WA

Job DescriptionJob SummaryNegotiates agreements with highly visible providers who are strategic to the success of the Plan, including integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers.Knowledge/Skills/Abilities• In conjunction with Director/Manager Provider Contracts,...

Senior Provider Contracts Specialist

Molina Healthcare - Long Beach, CA

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 be house...

Specialist, Community Engagmnt (Field)

Molina Healthcare - Syracuse, NY

Job DescriptionJob SummaryResponsible for achieving established goals improving Molina's enrollment growth objectives encompassing all lines of business. Works collaboratively with key departments across the enterprise to improve overall choice rates and assignment percentages.Knowledge/Skills/Abilities• Under limited supervision, responsible fo...