Senior Level Analyst Provides senior level analyst support 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 Analyzes claims,
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
Job Title Leads and manages team responsible for process improvement initiatives that result in operational efficiencies and/or increase customer satisfaction. Assists in development of enterprise process improvement methodologies and the implementation of business process improvement capabilities.
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 analyst support for finance activities including financial analysis, reporting, forecasting, trending and modeling to support planning for future business decisions for the Kentucky Health Plan. Essential Job Duties Gathers, interprets and
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
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 Description Job Summary Leads and directs a team responsible for financial analysis activities across designated business areas - focusing on operational performance and strategic partnerships. Facilitates analysis, modeling, and forecasting to uncover business insights, develop
Job Title Care Manager RN Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes
Job Description Job Summary Will require to be infield twice a week subject to change Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary
Job Description Provides support for pharmacy Medication Therapy Management (MTM) activities. Contributes to overarching pharmacy strategy to ensure member access to medically necessary prescription drugs, optimization of medication related health care outcomes, and quality cost-effective member care.
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
Dental Clinical Reviewer Provides support and subject matter expertise for member clinical dental review activities. Responsible for determining appropriateness and medical necessity of member dental care services - targeting opportunities for quality improvement and satisfaction for
Job Title Provides lead level 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
Job Description Job Summary: Provides non-clinical administrative support to utilization management team and contributes to interdisciplinary efforts supporting provision of integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member
Job Title Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures
Job Description Job Summary Provides support for critical incident management activities, including provision of critical incident management referral support to members. Strives to ensure member progress toward desired outcomes in conjunction with interdisciplinary team facilitating integrated
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 Description Shift: M-F 11am- 7:30pm EST Hours 10am - 6:30pm PST Hours JOB DESCRIPTION Job Summary Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for
Job Title Provides support for clinical member services review assessment processes. Job Summary Verifies that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through