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 laser focused
Job Title 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 behavior change through actionable data
Member Engagement & Interventions Senior Specialist The Member Engagement & Interventions (MEI) Senior Specialist is responsible for managing, and executing member engagement programs that drive behavior change, improve health outcomes, and support overall plan performance. This
Senior Specialist, Quality Program Management and Performance The Senior Specialist, Quality Program Management and Performance implements new and existing healthcare quality improvement activities to maintain compliance with quality program requirements and reporting and monitoring for key quality program activities. Acts as
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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
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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.
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
Assistant Property Manager (Remote) – East Bay, CA Note on Remote Work - This role is remote insomuch that you will not have to come into our headquarters. You will still be expected to go to
Job Title Provides support 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 within the Molina network.
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
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 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 Title Provides senior level support for marketing and communications operations activities across the Molina enterprise. Job Description Supports the development and maintenance of marketing and communications workflows, campaign schedules, and projects, and ensures successful media
Job Description 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 business