Jobs at Molina Healthcare

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Medical Records Collector

Molina Healthcare - Columbus, OH

Job DescriptionJob SummaryMolina'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, Compliance

Molina Healthcare - Irving, TX

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...

Case Manager Medicaid Team

Molina Healthcare - Columbus, OH

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...

Specialist, Community Engagement Toledo Area

Molina Healthcare - Columbus, OH

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...

Examiner, Claims

Molina Healthcare - Boise, ID

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 ...

Assoc Rep, Provider Services

Molina Healthcare - Augusta, ME

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...

NOC Supervisor, IT Services

Molina Healthcare - Long Beach, CA

Job Description Required Skills• All Senior Engineer skills, including: o Strong interpersonal and communication skills o Ability to solve problems quickly and automate processes o A solid understanding of an operating system o A solid understanding of networking/distributed computing environment concepts o A solid understanding of pr...

Case Manager, LTSS (Columbus)

Molina Healthcare - Columbus, OH

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...

Case Management Processor

Molina Healthcare - North Charleston, SC

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...

Dir, Healthcare Services IL

Molina Healthcare - Oak Brook, IL

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 desired o...

Case Management and Utilization Management (RN)

Molina Healthcare - Milwaukee, WI

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...

Supervisor, Care Review - RN (Remote)

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 toward d...

Pharmacy Service Rep.

Molina Healthcare - Midvale, UT

Job DescriptionJob SummaryHandles provider phone calls regarding pharmacy claims processing in a call center setting. Satisfactorily resolve calls within expected response time standards.Knowledge/Skills/Abilities• Handles inbound pharmacy call volume.• Responds to incoming calls mainly from providers, as required to meet departmental goals....

AVP, Health Plan Quality Improvement

Molina Healthcare - Columbus, OH

Job Summary The AVP, Health Plan Quality Improvement will serve as a leader of the health plan Quality strategy and activities, including but not limited to leadership and primary Molina interface with state agencies, leadership of local Quality committees and oversight of intervention activities intended to improve quality measures and outcomes, You will collaborate with MHI Qual...

Healthcare Analytics Analyst

Molina Healthcare - Columbus, OH

Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.Knowledge/Skills/AbilitiesDevelop ad-hoc reports using...