Jobs at Molina Healthcare - Page 5

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Displaying results 61 - 75 of 494

Case Manager - Remote (Mason County Only)

Molina Healthcare - Bothell, WA

Job Description Job Summary Molina 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...

Field Case Manager, Behavioral Health Metro East-Southern IL

Molina Healthcare - Oak Brook, IL

Job Description Job Summary Molina 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...

Care Review Processor

Molina Healthcare - Cincinnati, OH

Job Description Job Summary Molina 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...

Community Behavioral Health Liaison

Molina Healthcare - Spokane, WA

Job Description Job Summary Molina'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/Abilities • Serves as liaison between plan an...

Sr. Abstractor, HEDIS/Quality Improvement

Molina Healthcare - Bothell, WA

Job Description Job Summary Molina's Quality Improvement Sr. Abstraction team functions to conduct data collection and abstraction of medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The abstraction team will meet chart abstraction productivity standards as well as minimum over read standards. Knowledge...

Analyst, Data

Molina Healthcare - Long Beach, CA

Job Description Job Summary Accountable for enrollment to premium related analysis for the organization. Responsible to ensure accurate and timely reconciliation and reporting of premium for month-end to management and corporate accounting for journal entries. Additionally responsible for creating queries to support reporting for accounting and enrollment & prem...

Analyst, Provider Configuratio

Molina Healthcare - Columbus, OH

Job Description Job Summary Responsible 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 housed on...

Medical Claim Review Nurse

Molina Healthcare - Troy, MI

Job Description Job Summary Responsible 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...

Sr Analyst, Data

Molina Healthcare - Long Beach, CA

Job Description Job Summary Designs 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 unstructured data fr...

Sr Analyst, MITA Systems

Molina Healthcare - Long Beach, CA

Job Description Job Summary Business subject matter expert for specific MITA areas and is responsible for preparing meeting materials, configuration artifacts, reviewing test cases and test data, and providing ad-hoc training to support new MMIS DDI efforts or ongoing site operations. Knowledge/Skills/Abilities • Delivers project customer scope for ...

Delegation Oversight Nurse-Remote

Molina Healthcare - Bothell, WA

Job Description Job Summary Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and State Medicaid requirements including delegation standards and requirements contained in the delegation agreement. Knowledge/Skills/Abilities The Deleg...

Care Review Clinician, Inpatient Review (RN) - REMOTE - (7 Positions)

Molina Healthcare - Bothell, WA

Job Description Job Summary The Care Review Clinician, Inpatient Review 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. Healthcare Services (HCS) staff work to ensure that p...

Rep, Provider Services

Molina Healthcare - Doral, FL

Job Description Job Summary Molina 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...

Sr Specialist, Delegation Oversight-Remote

Molina Healthcare - Bothell, WA

Job Description Job Summary Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with DMHC and DHCS requirements including delegation standards and requirements contained in the Molina Medical Compliance and Fraud, Waste and Abuse Program. Knowledge/Skills/A...

Bilingual Member Services Rep (Multiple Openings)

Molina Healthcare - Long Beach, CA

Job Description Job Summary Provides 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 relationships. R...