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Jobs at Molina Healthcare

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Lead, Core Ops

Molina Healthcare - Long Beach, CA

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/Ski...

Director, Business Architecture (REMOTE)

Molina Healthcare - Long Beach, CA

Job Description Job Summary Focuses 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 set strategic direction from general enterprise-wide direc...

Transition of Care Coach (RN)

Molina Healthcare - Spokane, 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 desi...

Specialist, Provider Contracts

Molina Healthcare - Long Beach, CA

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 o...

Supv, Member Services

Molina Healthcare - Irving, TX

Job Description Job Summary Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.

Care Review Processor

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 ...

Sr Analyst, Business

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 specific...

Case Manager - North Sound/Snohomish

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 desi...

Analyst, Healthcare Analytics

Molina Healthcare - Doral, FL

Job Description Job Summary 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/Abilities

Sr Engineer, Applications

Molina Healthcare - Long Beach, CA

Job Description Job Summary Designs, develops, and communicates technology models and foundations used to run applications, data, and infrastructure in support of one or more business processes. Applies and promotes key principles (e.g. stability, scalability, performance, security, compatibility, re-use), helping ensure a balance between tactical and strategic tec...

Registered Nurse (RN) Auditor, Clinical Services

Molina Healthcare - Milwaukee, WI

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 Analyst, Data

Molina Healthcare - Irving, TX

Job Description Job Summary Working within Enterprise Information Management – Data Transformation and Data Ingestion team the Sr.Big Data Analyst will be responsible for data profiling and mining to discover ,analyze and elaborate on the data sources and the requirements from the various analytical and reporting teams. Technologies include Big Data Tec...

Provider Services Rep

Molina Healthcare - San Diego, CA

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 Service...

Care Review Processor

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 desi...

Sr. Network Engineer, EIS

Molina Healthcare - Long Beach, CA

Job Description Plan, design, and implement Multi Cloud network systems, including configurations and support. Independently troubleshoot network issues and investigate underlying problems. Coordinate with vendors for the installation of required items, to include Cisco Routers, Switches and Firewalls. Evaluate and implement changes in conjun...