Company Description Support veteran-focused healthcare where your pharmacy knowledge, customer service skills, and attention to detail help Veterans access medications and pharmacy support services from a remote role. At International SOS Government Medical Services, youll support healthcare
Medical Coding Dispute Investigator Provides support for provider denial coding dispute activities. Investigates and resolves disputes related to provider appeals, and ensures that claims adhere to correct billing standards and regulations. Essential Job Duties Reviews coding-related
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
Job Description JOB DESCRIPTION Provides support to Molina functional areas through program management, including policy, workflow and process documentation, management of program controls, vendor practices, budgets, governance frameworks, playbooks and best practices, and champion networks, as
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 Provides support to Molinas Medicare segment through program management, including governance frameworks, internal and partner capability delivery oversight, program controls, playbooks and best practices, as applicable. Serves as a key interface between the Medicare
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 AVP Enterprise Architecture Job Description Reporting to the Chief Digital Officer, the AVP Enterprise Architecture is responsible for designing and communicating the shared architectural vision and standards for the Information Technology organization to drive
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 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.
Job Title Provides support for health plan provider engagement activities. Drives value-based care strategies through risk adjustment and quality improvement activities. Ensures smaller, less advanced tier II and tier III providers have engagement plans to meet
Job Title Leads and manages 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
Compliance Auditor Provides support for compliance auditing activities. Responsible for evaluating Molinas adherence to regulatory requirements, internal policies, and health care industry standards by identifying compliance gaps and recommending improvements to mitigate risk related to fraudulent
Job Title Job Title Job Description Job Summary Provides analyst support for delegation oversight activities including monitoring delegation oversight to ensure compliance with state, federal, National Committee for Quality Assurance (NCQA), and Molina requirements. Responsible for
Job Title Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors
Business Analyst, Provider Network Molina Healthcare is hiring for a Business Analyst, Provider Network. Highly qualified candidates will have the following experience: Salesforce knowledge, a certification is helpful Managed Care / Healthcare experience in the Provider