Job Description Job Summary Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, planning and issue/risk management. Knowledge/Skills/Abilities Ability to manage multiple complexes, challenging
Care Manager RN 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
Actuarial Analyst Provides entry level support for actuarial function activities including extracting, analyzing, and synthesizing data from various sources to identify risks. Estimates liabilities, establishes premium rates, and supports financial analysis and reporting. Essential Job Duties
Job Description Provides senior level support for claims recovery activities including researching claim payment and billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider compliance. Collaborates with health plans and vendors to
Job Title Provides support and ownership for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities and improve financial performance. Essential Job Duties Extracts and compiles data
Claims Research Analyst 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
Job Title Leads and directs team responsible for configuration activities including accurate and timely implementation and maintenance of critical information on claims databases, validation of data stored on databases, and adherence to health plan business and
Job Title Job Description Job Summary Provides senior level support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes Uses a consultative approach emphasizing physician engagement and
AVP Of Maternal & Child Clinical Operations The AVP of Maternal & Child Clinical Operations provides strategic leadership and operational oversight for enterprise-wide maternal, newborn, and child health programs. This leader ensures high-quality, equitable, evidence-based care management
Job Title Leads and directs team responsible for government contracts activities. Essential Job Duties Leads and directs team responsible for management of regulatory and contractual requirements related to government programs including, but not limited to, Medicaid, Medicare,
Job Title Provides senior level support for health education activities. Job Summary Responsible for developing, implementing, and maintaining health plan health education programs. Assists in identifying health education program needs, researching and developing health education and disease management
Job Title Provides lead level clinical support to healthcare services team supporting one or more of the following functions: care management, utilization management, care transitions, long-term services and supports (LTSS), behavioral health, and other clinical programs, and collaborates
Pharmacy Technician Molina Healthcare is hiring for remote Certified Pharmacy Technicians. These roles will be in our Prior Authorization department. You will review prior auth requests that are submitted. Shift times for these roles will be
Job Title Behavioral Health Clinical Reviewer Job Description Job Summary Provides support for member clinical service review processes specific to behavioral health. Responsible for verifying that services are medically necessary and align with established clinical guidelines,
Job Title Provides support for care management and care coordination activities and collaborates with a multidisciplinary team to coordinate the integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes
Job Title Provides senior-level analytical support for medical economics initiatives, including extracting, analyzing, and synthesizing data from multiple sources. Identifies and quantifies cost-saving opportunities and communicates insights clearly in presentations to support broader understanding and adoption.
Job Title Investigative Support for Special Investigation Unit (SIU) Activities Provides investigative support for special investigation unit (SIU) activities. Responsible for supporting for the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to
Job Title Provides subject matter expertise and leadership for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers
Job Description Provides senior level support for all aspects of taxation including compliance, planning, forecasting, merger and acquisition (M&A) evaluation, expense, liability and asset recordation, securities and exchange (SEC) and statutory reporting disclosure, Sarbanes-Oxley (SOX) compliance,
Job Title Claims Adjudication Support Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. Essential Job Duties Responds to