Jobs at Molina Healthcare - Page 5

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Manager, Provider Inquiry R&R (Claims Disputes)

Molina Healthcare - Long Beach, CA

Job Description Job SummaryProvider Inquiry/Services staff are responsible for the submission, research, and resolution of provider inquiries and/or disputes. They respond with the answer to all incoming inquiries and coordinate with other Molina departments as needed to resolve the issue, as well as to correct the underlying cause, ensuring that res...

Specialist, Facilities

Molina Healthcare - Jackson, MS

Job DescriptionJob SummaryMolina's Facilities function is responsible for the efficient planning, design, integration and operation of the different elements that make up a work environment. Depending on location, this includes: day-to-day facility operations management and administrative services (e.g., mailroom, reception, relocation/move support, mainte...

Care Review Clinician, Inpatient Review (LPN/LVN)

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 toward desir...

Sr. Specialist, Quality Interventions/QI Compliance

Molina Healthcare - Bothell, WA

Job DescriptionJob SummaryMolina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities...

Sr. Abstractor, HEDIS/Quality Improvement

Molina Healthcare - San Antonio, TX

Job DescriptionJob SummaryMolina'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...

Lead, Core Ops

Molina Healthcare - San Juan, Puerto Rico

Job DescriptionJob SummaryResponsible 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/Skil...

Full-Time Member Services Reps (20 Openings,Bilingual/Spanish Required)

Molina Healthcare - Jackson, MS

Job DescriptionProvide new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions and complaints. Resolvemember inquiries and complaints fairly and effectively. Provide product and service information to members, and identifies opportunities to maintain and increase member relationships. Recommend and implement program...

RN SIU Investigator - PR

Molina Healthcare - San Juan, Puerto Rico

Job DescriptionJob SummaryThe Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing revi...

Supv, Care Review Prior Authorization (Nurse)

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 ...

Care Review Processor

Molina Healthcare - Long Beach, CA

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...

Auditor, Compliance

Molina Healthcare - Long Beach, CA

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...

Sr Rep, Provider Services

Molina Healthcare - Midvale, UT

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. Prov...

Applications Manager

Molina Healthcare - Long Beach, CA

Job Description Job summary: Responsible for end to end management of member enrollment process design, development and operations supportMentors and guides the team on end to end solutionRecommend software tools and development approaches that could benefit the department projectsEffectively communicates and collaborates with busines...

Applications Engineer

Molina Healthcare - Long Beach, CA

Job Description Job summary: Responsible for designing, developing, coding, unit testing, and debugging new software and producing significant enhancements to existing software. Conducts business process analysis, participates in design sessions with Architects in order to align information technology solutions with business initiatives. Applies and promotes key princip...