Jobs at Molina Healthcare

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Sr Analyst, Healthcare Analytics

Molina Healthcare - Syracuse, NY

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.Experience in Medical Economics and Strong Knowledge of Performa...

Care Review Processor

Molina Healthcare - Syracuse, NY

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...

Care Review Clinician, Inpatient Review (BH)

Molina Healthcare - Syracuse, NY

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...

Field Case Manager-(Behavioral Health) LMHC or Psychiatric RN

Molina Healthcare - Syracuse, NY

Job DescriptionNew York Plan Specific. The contract with the New York plans requires for this role to be have what is listed below. This role cannot be staffed with a Registered Nurse. Minimum of Associates Degree or Advanced Degree in Behavioral Health field, example a LMHC or LMSWThis license needs to be unrestricted license to practice ind...

Field Case Manager-(BH) LMHC or Psychiatric Nurse

Molina Healthcare - Syracuse, NY

Job DescriptionNew York Plan Specific. The contract with the New York plans requires for this role to be have what is listed below. This role cannot be staffed with a Registered Nurse. Minimum of Associates Degree or Advanced Degree in Behavioral Health field, example a LMHC or LMSWThis license needs to be unrestricted license to practice ind...

Provider Services Rep

Molina Healthcare - Syracuse, NY

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. Provi...

Peer Specialist

Molina Healthcare - Syracuse, NY

Job DescriptionJob SummaryMolina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs.Knowledge/Skills/Abilities• Provides peer support services fo...

Specialist, Community Engagmnt (Field)

Molina Healthcare - Syracuse, NY

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...

Lead, Provider Inquiry R&R

Molina Healthcare - Syracuse, NY

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.Provide...

Sr. Healthcare Analyst (Medicaid Encounters)

Molina Healthcare - Syracuse, NY

Job Description Job SummaryPerforms research and analysis of medical, pharmacy and dental encounters. Evaluates, writes, and presents analyses and makes recommendations based on relevant findings.Knowledge/Skills/Abilities• Ensure beginning-to-end encounter process is compliant with federal and state requirements; provide and imple...

Clinical Appeals Nurse (3+ Years of Hospital Acute Care Experience)

Molina Healthcare - Syracuse, NY

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...

LMSW Field Case Manager

Molina Healthcare - Syracuse, NY

Job DescriptionNew York Plan Specific: This role requires a Licensed in the State of New York Social Worker who will be caring a Case Load of members and responding to their social needs along with the Registered Nurse Case Managers and Transition of Care Nurses. It is a team approach. This position is remote in the field. You would only need to attend occasional meetin...

RN Case Manager :Field Nurse: Syracuse area -New York

Molina Healthcare - Syracuse, NY

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...

Sr. Abstractor, HEDIS/Quality Improvement

Molina Healthcare - Syracuse, NY

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. Our Ideal candidate will...

Director, Health Plan Quality Improvement

Molina Healthcare - Syracuse, NY

Job DescriptionJob Summary The Director serves as the Quality Improvement leader for the State Health Plan and leads programs involving HEDIS, NCQA accreditation, risk scores for Medicare and Medicaid, CAHPS, and Performance Improvement Plans (PIP) for New York State. Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare...