Pharmacist Position Molina Healthcare is hiring a Pharmacist in our Utilization Management/Prior Auth department. This position will be working Monday through Friday from 10:00am to 6:30pm CST with rotating weekends and holidays. Candidates can be licensed in
Job Title Provides non-clinical administrative support to the care management function, and contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member
Job Title Provides subject matter expertise and leadership for Medicare Stars quality improvement (QI) programs and activities. Provides subject matter expertise in planning and implementing QI initiatives and education programs to support improved Medicare Star ratings. Responsible for
Project Controls Specialist (Hybrid) Long Beach & Los Angeles, CA What We’re Looking For: Michael Baker International is seeking a Project Controls Specialist to support project delivery across our Long Beach and Los Angeles offices. This role
Description Location: Long Beach, CA (Hybrid) Job Type: Full-Time Schedule: Hybrid schedule is 2 days in-clinic 8-hour shift Monday to Friday Day Shift We are looking for a compassionate person who loves an opportunity to make
Verizon recently acquired Frontier and plans to transition non-union Frontier employees into Verizon compensation and benefits programs. This position will be part of that planned transition. Who we are: As the largest pure-play fiber provider in the
Who We Are: Since 1906, New Balance has empowered people through sport and craftsmanship to create positive change in communities around the world. We innovate fearlessly, guided by our core values and driven by the belief
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 members reach
Job Title Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through
Job Title Manages team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance. Collaborates with health plans identify and track savings
Federal Account Executive (Remote) Position remote, open to anywhere in the United States of America. Overview Are you looking for an opportunity to advance your career in the technology sales industry? Come join VectorUSAs Federal Sales
Sr Quality Improvement/HEDIS Specialist Molina Healthcare of Ohio is hiring for a Sr Quality Improvement/HEDIS Specialist on our Health Plan Community Interventions team. This role is remote however candidates must live in Ohio. This role is
Job Title Provides senior level support for delegation oversight activities. Oversees delegated activities to ensure compliance with state, federal, contractual, National Committee for Quality Assurance (NCQA), and Molina requirements. Essential Job Duties Under general leadership supervision,
Job Title Leads and supervises team responsible for payment integrity activities including recovery operations. Responsible for performance, quality levels and establishing procedures and techniques that achieve optimal payment integrity operational standards and production targets. Essential Job
Claims Support Specialist 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
Job Title Leads and directs team responsible for multi-state delegation oversight activities including monitoring of delegation oversight to ensure compliance with state, federal, National Committee for Quality Assurance (NCQA), and Molina requirements. Collaborates closely with internal
Job Description Leads and manages team responsible for health plan provider engagement activities. Collaborates with senior leadership and the health plan network team to drive value-based care strategies, and operational direction for risk adjustment and quality
Job Title 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 data-driven solutions,
Job Description Leads and manages team responsible for special investigation unit (SIU) activities, specifically the prevention and detection of violation of applicable laws and regulations. Responsible to protect the business from liability of fraudulent or abusive
Job Title Provides executive level strategy and leadership for teams responsible for optimization of clinical operations across the enterprise. Develops and implements processes to ensure healthcare services functions including utilization management/care management/etc. and clinical vendors provide services in