Clinical Auditor Position This position will offer remote work flexibility, but the selected candidate must reside in Nebraska. Opportunity for a Registered Nurse who has a US license in good standing to join our Medicaid Team
Job Title Molina Healthcare is hiring for a CSR for our Medication Therapy Management department. Job Description This role will be working Monday through Friday 10am to 6:30pm Mountain Standard Time. Highly qualified candidates will have
Sr. Director, Member Engagement Operations Homebase Medical is getting back to basics. Our mission is to optimize the quality of life for homebound older adults, allowing them to live independently and with dignity in their own
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 applicable. Job
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
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 programs that improve
P2S|CMTA stands as a provider of professional engineering services to a broad range of markets, including higher education, healthcare, ports/harbors, industrial, entertainment, commercial, laboratories, municipal, and federal sectors. Our specialties include electrical, mechanical, plumbing, fire protection, and
Job Description 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 and contributes to overarching strategy
Job Title Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record
Job Title Provides senior level support for Molina enterprise quality improvement abstraction activities. Job Description Responsible for data collection and abstraction of medical records for Healthcare Effectiveness Data and Information Set (HEDIS) and HEDIS-like initiatives and
Compliance Analyst Provides analyst support for compliance activities. Seeks to ensure the organization adheres to regulatory requirements, industry standards, and Molina internal policies, and prevent and/or detect violation of applicable laws and regulations, and protect the
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
Job Description Job Summary Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems
Job Title Provides senior level support for Molina Physical Security enterprise applications. Job Description Provides senior level support for Molina Physical Security enterprise applications. Responsible for executing and managing the applications that support physical security operations,
Lead Analyst Molina Healthcare is hiring for a Lead Analyst that will handle Provider and Facility Reimbursements. This team has oversight for all lines of business within our facility reimbursement scope. This team mixes some technical
Job Title Leads and supervises team responsible for provision of support center customer service excellence to meet the needs of Molina members and providers. Ensures issues and needs are addressed fairly and effectively, and in alignment with
Member Services Review Assessment Specialist Provides support for member services review assessment activities for a specific area of specialty. Responsible for ensuring that services are medically necessary, align with established clinical guidelines, insurance policies, and regulations, and that members
Audit Support For Enterprise Risk Adjustment Provides audit support for Molina enterprise risk adjustment activities. Responsible for developing, recommending and implementing controls and cost-effective approaches to minimize the organizations risks effects. Identifies and analyzes potential sources
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