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Jobs at Molina Healthcare

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Sr. Medical Director, Health Plan

Molina Healthcare - Louisville, KY

Knowledge/Skills/Abilities Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to Plan members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding ...

Specialist, Electronic Visit Verification

Molina Healthcare - Albuquerque, NM

Job Description Job Summary Analyzes 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...

Specialist, Delegation Oversight

Molina Healthcare - Irving, TX

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...

Sr Analyst, Finance

Molina Healthcare - Long Beach, CA

Job Description Job Summary Responsible 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. Abstractor, HEDIS/Quality Improvement - Remote

Molina Healthcare - Long Beach, CA

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/Skills/Abili...

Case Manager Home Care Coordinator ( Clark , Stevenson, or Klickitat County WA)

Molina Healthcare - Vancouver, 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...

Case Manager (RN)

Molina Healthcare - San Diego, CA

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...

Dir, Diversity & Inclusion

Molina Healthcare - Long Beach, CA

Job Description Job Summary The Director, Diversity and Inclusion (D&I) will direct the design and implementation of Molina's strategic company-wide D&I strategies, programs, and initiatives. This position will also be responsible for tracking and reporting D&I metrics and progress. Works cross-functionally within Human Resources and with senior leaders across the o...

Medical Director, Health Plan

Molina Healthcare - Long Beach, CA

Knowledge/Skills/Abilities Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to Plan members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regardi...

Program Manager (New Mexico Products)

Molina Healthcare - Albuquerque, NM

Job Description Job Summary: 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 engage and oversee the work of extern...

Associate, Actuarial Analyst

Molina Healthcare - Long Beach, CA

Job Description Job Summary Responsible for estimating liabilities, establishing premium rates, financial analysis and reporting. Extracts, analyzes, and synthesizes data from various sources to identify risks. Knowledge/Skills/Abilities • Support the development of the IBNR estimates and rate adequacy studies. Document assumptions. • Analyze re...

Mgr, Appeals & Grievances

Molina Healthcare - Louisville, KY

Job Description Job Summary Responsible 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 Medicaid

Medical Records Collector

Molina Healthcare - Long Beach, CA

Job Description Job Summary Molina's HEDIS/Quality Improvement Medical Records Collector will work collaboratively in outreaching to providers in order to pursue medical records via phone call, fax, mail, electronic medical record system retrieval and direct onsite pick up, for the HEDIS projects. Knowledge/Skills/Abilities • Under the direction of ...

AVP, Community & Member Engagement

Molina Healthcare - Bothell, WA

Job Description Job Summary Responsible 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 • In partnership with executive leadership,...

Assoc Rep, Provider Appeals & Disputes

Molina Healthcare - Bothell, WA

Job Description Job Summary Molina 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. Provide...