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Jobs at Molina Healthcare

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Clinical Appeals Nurse (RN)

Molina Healthcare - Troy, MI

Job Description Job Summary Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards. Knowledge/Skills/Abilities • The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request b...

Analyst, Provider Configuratio

Molina Healthcare - Long Beach, CA

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 and application of business rules as they apply to each database. Validate data to be housed on...

Specialist, Appeals & Grievances

Molina Healthcare - Midvale, UT

Job Description Job Summary Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid

Sr Analyst, Provider Configura

Molina Healthcare - Long Beach, CA

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 and application of business rules as they apply to each database. Validate data to be housed on...

Member Health Assessor

Molina Healthcare - Oak Brook, IL

Job Description Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desir...

Sr Business Analyst - Claims Process Improvement

Molina Healthcare - Long Beach, CA

Job Description Job Summary Analyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifica...

Sr. Specialist, Community Engagement (Bay City/Saginaw)

Molina Healthcare - Flint, MI

Job Description Job Summary Responsible for achieving established goals improving Molina's enrollment growth objectives encompassing all lines of business. Works collaboratively with key departments across the enterprise to improve overall choice rates and assignment percentages. Knowledge/Skills/Abilities • Under limited supervision, responsible fo...

Program Manager (Vendor Management & Healthcare experience required) - REMOTE

Molina Healthcare - Long Beach, CA

Job Description Job Summary The In-Home Assessment Program Manager is part of our innovative Risk Adjustment department to assist our diverse team of data leaders, risk adjustment experts, and developers in the development and implementation of business strategies, operations and vendor management related to in-home assessment activities in all government lines of b...

Analyst, Senior Provider Configuratio,

Molina Healthcare - Long Beach, CA

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 and application of business rules as they apply to each database. Validate data to be housed on...

Analyst, Data (SSRS/Power BI)

Molina Healthcare - Long Beach, CA

Data Analyst - (2003487) Primary Location :US-CA-Long Beach Job : Legal, Risk, & Compliance Organization :Corporate Job Type :Full-time Posting Date :August 2020 Job Description Job Summary Designs and implements processes and solutions associated with a wide varietyof data sets used for data/text mining, analy...

Care Review Processor

Molina Healthcare - Irving, TX

Job Description Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desir...

Director, Strategy & Capture (REMOTE)

Molina Healthcare - Long Beach, CA

Knowledge/Skills/Abilities The role, reporting directly to the VP of Strategy, is a critical member of the Strategy team, which supports senior executives in creating corporate, business unit, and local strategies as well as driving key strategic initiatives to transform the Company. Range of responsibilities include developing enterprise strategy, driving growth strategies for...

Sr Account Rep, Medicare-East Idaho Region

Molina Healthcare - Twin Falls, ID

Job Description Job Summary Responsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved market areas to achieve stated revenue, profitability and retention goals, while following ethical sales practices and adhering to established policies and procedures.

Analyst, Configuration Info Mgmt (Troy, MI)

Molina Healthcare - Troy, MI

Job Description Job Summary Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adhe...

Case Manager, LTSS

Molina Healthcare - Troy, MI

Job Description Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desir...