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Jobs at Molina Healthcare

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Care Review Clinician, Inpatient Review (RN)

Molina Healthcare - Syracuse, NY

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...

Medical Director (Medicare)

Molina Healthcare - Bothell, WA

Job Description Job Summary Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provision of medical staff services. Maintains a working knowledge of applicable national, state and local laws and regulatory requirements affect...

Auditor, Compliance (Remote)

Molina Healthcare - Louisville, KY

Job Description Job Summary: Establish 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 en...

Transition of Care Coach (RN)

Molina Healthcare - Milwaukee, WI

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...

Sr Business Analyst - Medicaid Enrollment - Remote

Molina Healthcare - Long Beach, CA

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...

Analyst, Network Strategy, Pricing & Analytics

Molina Healthcare - Long Beach, CA

Job Description Job Summary Responsible 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 sust...

Sr Account Rep, Medicare

Molina Healthcare - Long Beach, CA

Job Description Job Summary Responsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved market areas to achieve stated revenue, profitability and retention goals, while following ethical sales practices and adhering to established policies and procedures.

Sr Analyst, Config Info Mgmt

Molina Healthcare - Long Beach, CA

Job Description Job Summary Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adhe...

Auditor, Clinical Services

Molina Healthcare - Oak Brook, IL

Knowledge/Skills/Abilities • Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM). • Monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system an...

Sr Capacity Planner

Molina Healthcare - Long Beach, CA

Knowledge/Skills/Abilities Develop and deploy workforce management strategies nationwide. Partner with leaders by strategically identifying business needs, and propose solutions in line with the needs of our members and providers. Requires contact center experience with in-depth Workforce Management experience specializing in planning efforts. Ensures the right numbers of skilled ...

Care Review Clinician, PA (RN)

Molina Healthcare - Syracuse, NY

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...

RN Program Manager, Delegation Oversight

Molina Healthcare - Albuquerque, NM

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...

Delivery Manager

Molina Healthcare - Long Beach, CA

Job Description Job Summary The Delivery Manager will be responsible in delivering various technical projects that involves in (Compute, Storage, Network, Data Management) migration to Azure. The incumbent in this role will be closely working with PMO, Project technical team in delivering our key initiatives. The Delivery Manager will drive the deliverables with tec...

Case Manager (RN) - East Dallas Counties

Molina Healthcare - Irving, TX

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...

Lead Analyst, Config Info Mgmt (QNXT)

Molina Healthcare - Long Beach, CA

Job Description Job Summary Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adhe...