Jobs at Molina Healthcare

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Dir, Healthcare Services

Molina Healthcare - Syracuse, NY

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 desir...

Specialist, Community Engagement (FIELD MARKETING REP - Cortland/Tompkins Counties)

Molina Healthcare - Cortland, NY

Job Description Job Summary Responsible 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...

Rep, Member Engagement

Molina Healthcare - Syracuse, NY

Job Description Job Summary Provides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions and complaints. Resolves member inquiries and complaints fairly and effectively. Provides product and service information to members, and identifies opportunities to maintain and increase member relationships. R...

Encounters Sr. Healthcare Analyst

Molina Healthcare - Syracuse, NY

Performs research and analysis of medical, pharmacy, and dental encounters. Evaluates, writes, and presents analyses and makes recommendations based on relevant findings. Experience in Encounters, X12 File, Medical Economics and Strong Knowledge of Performance Indicators: SQL programming, SQL Server Reporting Services (SSRS), PowerBI, Medinsight, RxNavi...

Provider Contracts Manager

Molina Healthcare - Syracuse, NY

Job Description Job Summary Negotiates agreements with highly visible providers who are strategic to the success of the Plan, including integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers. Knowledge/Skills/Abilities • In conjunction with Director/Manager Provider Contracts,...

Sr. Abstractor, HEDIS/Quality Improvement

Molina Healthcare - Syracuse, NY

Job Description Job Summary Molina'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...

Analyst, Healthcare Analytics

Molina Healthcare - Syracuse, NY

Job Description Job Summary The Analyst, Healthcare Analytics will perform 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. ...

Analyst, Coding (Certified Coder/CPC or CCS)

Molina Healthcare - Syracuse, NY

Job Description Job Summary Establish 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, LTSS - Field

Molina Healthcare - Syracuse, NY

Job Description New York Plan Specific: This role requires a Registered Nurse with an unrestricted license. You will be helping our members to connect with the Long Term Services, which may include Skilled Nursing Facilities, Home Health, Assisted Living and other community resources. We use UAS as a screening tool for our LTSS Evaluations. Experience with this tool is extremely ...

Case Manager (RN) FIELD REMOTE

Molina Healthcare - Syracuse, NY

Job Description The State of New York Contract requires that this role be filled with a Registered Nurse with an unrestricted license in the state of New York. Remote for this role means field based or community based. Once a month meeting in office minimum. Rest of time is member visits at provider offices and/or home and documentation at home. Ratio of time...

Sr Finance Analyst, Healthcare Analytics Syracuse, NY

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. SQL knowledge and daily working with developing ad-hoc reports using SQL p...

Assoc Specialist, Provider Contracts

Molina Healthcare - Syracuse, NY

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 on...

Specialist, Quality Interventions/QI Compliance

Molina Healthcare - Syracuse, NY

Job Description Job Summary Molina'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...

Associate Specialist, Quality

Molina Healthcare - Syracuse, NY

Job Description Job Summary The Associate Specialist, Quality will be responsible for planning, developing and directing the implementation of techniques to ensure the maintenance of performance and quality levels in the Business' products and processes. Reviews product designs and establishes procedures and techniques for the control of quality standard...

Nurse Practitioner: Field /Syracuse, NY (Onondaga County)

Molina Healthcare - Syracuse, NY

Job Description Job Summary Care Connections, a division of Molina Healthcare, seeks Nurse Practitioners to join its growing team which will contribute to the company mission to bring quality health care to the underserved. The Care Connections NPs focus on screening and preventive primary care services delivered in the home, community and nursing facility settings....