Molina Healthcare Careers

Job Summary The Manager, Business Development, Facilitated Enrollments, is responsible for for overseeing daily operations and driving individual and team performance. The Manager will lead a team of Facilitated Enrollers in a designated region(s) making data-informed decisions to drive performance, resource allocation and lead generation. This is a …

JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties Facilitates comprehensive research and resolution …

JOB DESCRIPTION Job Summary: Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements, accreditation standards and organizational performance standards - ensuring quality compliance and desired member outcomes and effective clinical operations. Contributes to overarching strategy to provide quality and cost-effective …

JOB DESCRIPTION Job Summary Leads and directs team providing integrated behavioral health/chemical dependency services, and collaborates with multidisciplinary care team working across the continuum. Participates with senior leadership to establish strategic plans and objectives. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality …

JOB DESCRIPTION Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Essential …

Job Summary The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. This position …

JOB DESCRIPTION Job Summary Facilitates advanced practice clinical consultations for enrolled members including in-home histories, physical assessments and care plans; strives to ensure member progress toward desired member outcomes in conjunction with interdisciplinary team facilitating care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. …

JOB DESCRIPTION Job Summary Provides support for pharmacy technician activities. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job Duties Performs initial receipt and review of non-formulary or prior authorization requests against pharmacy plan approved criteria; requests additional information …

JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties Facilitates comprehensive research and resolution …

JOB DESCRIPTION Job Summary Provides support for member correspondence activities. Responsible for generating clinical determination letters for members and providers, and following established guidelines and standards related to correspondence processing. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties Assists with generating clinical determination letters …

JOB DESCRIPTION Job Summary The Specialist, Practice Transformation implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Drives provider practices to ensure assigned Tier 2 & Tier 3 Practice Transformation plan is in place and carried out to meet annual …

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 …

JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide …

JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide …

JOB DESCRIPTION Job Summary Molina Healthcare's Medicare Compliance team supports Medicare operations for the Molina Medicare product lines. It is a centralized corporate function supporting compliance activities. KNOWLEDGE/SKILLS/ABILITIES The Compliance Analyst position is primarily responsible for Medicare Oversight. Provide regulatory expertise to the Organization: both State and Federal Have working …