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 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
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,
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
Delegation Oversight Lead 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
Job Description Job Summary 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,
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 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 Title Leads and directs team responsible for government contracts activities. Job Description Leads and directs team responsible for development and administration of contracts with state and/or federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored
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 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 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
Lead, Medicare Administration Molina Healthcare is hiring a Lead, Medicare Administration. This will be a remote position on our team that is responsible for our Medicare product- both Bids and Member Materials. Highly qualified candidates will
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 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,
Job Title Provides subject matter expertise in the delivery, execution and maintenance of products. Accountable for maximizing the value of assigned technical products that support enterprise operations. Owns the product vision, backlog, and delivery outcomes and
Technical Coordinator Provide hands on technical coordination across engineering, platform, data, security, and operations teams. Focus on troubleshooting, solution alignment, and execution support. Partner with engineers and architects to resolve issues and move work forward. Support
Job Title Project Manager Job Description Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, planning and issue/risk management. Knowledge/Skills/Abilities Deep understanding of