Jobs at Molina Healthcare - Page 3

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Analyst, Data

Molina Healthcare - Long Beach, CA

Job Description Job SummaryDesigns 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 unstructu...

Information Security Compliance Engineer - HIPPA

Molina Healthcare - Long Beach, CA

Job Summary Responsible for ensuring Molina compliance with both regulatory and company Information Security policies. Conduct various types of Information Security compliance and risk assessments. Monitor compliance by internal business units with security standards and policies. Maintain an awareness of state, federal, and company-established Information Security regulation...

Analyst, Special Investigation Unit

Molina Healthcare - Long Beach, CA

Job Description Job 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 ...

Medical Director, Health Plan

Molina Healthcare - Long Beach, CA

Job Summary Bring your utilization review experience & physician leadership to our growing health plan. You will play an integral part in medical oversight to determine medical necessity of healthcare services provided to our members, targeting improvements in efficiency and satisfaction for patients and providers. You will also have the opportunity to educate and intera...

Supervisor, Care Management

Molina Healthcare - Edinburg, TX

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 ...

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 pri...

Analyst, Healthcare Analytics

Molina Healthcare - Oak Brook, IL

Job Description Job SummaryPerforms 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/Abilit...

Case Manager (Field Based in Skagit County, WA)

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 ...

Specialist, Provider Contracts

Molina Healthcare - Columbus, OH

Job DescriptionJob SummaryResponsible 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 ...

Manager, Quality Interventions

Molina Healthcare - Syracuse, NY

Job DescriptionJob SummaryThe Manager, Quality Interventions assists the Director and AVP in developing, implementing and monitoring the success of Molina national and/or plan-level Quality Improvement activities, including intervention projects, problem resolution and management of staff and contractors. The Manager is part of the Senior Leaders...

Assoc Specialist, Appeals & Grievances

Molina Healthcare - Doral, FL

Job DescriptionJob SummaryMolina Healthcare's Appeals & Grievances jobs are 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.Knowledge/Skills/Abilities• ...

Director, Health Plan Quality Improvement

Molina Healthcare - Long Beach, CA

Job DescriptionJob SummaryThe Director serves as the Quality Improvement leader for the State Health Plan and leads programs involving HEDIS, NCQA accreditation, STAR ratings, risk scores for Medicare and Medicaid, CAHPS, HOS, Rx adherence, and state requested reports and projects. This is a regional position that covers the following states: Cali...

Assoc Rep, Provider InquiryR&R

Molina Healthcare - Albuquerque, NM

Job DescriptionJob SummaryMolina 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.

Care Review Clinician, Prior Authorization

Molina Healthcare - Albuquerque, NM

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 ...

Assoc Analyst, Finance

Molina Healthcare - Bothell, WA

Job DescriptionJob SummaryResponsible 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 forecas...