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Jobs at Molina Healthcare

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Analyst, Healthcare Analytics

Molina Healthcare - Doral, FL

Job Description Job Summary Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. Knowledge/Skills/Abilities

Sr Engineer, Applications

Molina Healthcare - Long Beach, CA

Job Description Job Summary Designs, develops, and communicates technology models and foundations used to run applications, data, and infrastructure in support of one or more business processes. Applies and promotes key principles (e.g. stability, scalability, performance, security, compatibility, re-use), helping ensure a balance between tactical and strategic tec...

Registered Nurse (RN) Auditor, Clinical Services

Molina Healthcare - Milwaukee, WI

Knowledge/Skills/Abilities • Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM). • Monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system an...

Sr Analyst, Data

Molina Healthcare - Long Beach, CA

Job Description Job Summary Working within Enterprise Information Management – Data Transformation and Data Ingestion team the Sr.Big Data Analyst will be responsible for data profiling and mining to discover ,analyze and elaborate on the data sources and the requirements from the various analytical and reporting teams. Technologies include Big Data Tec...

Provider Services Rep

Molina Healthcare - San Diego, CA

Job Description Job Summary Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Service...

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 desi...

Sr. Network Engineer, EIS

Molina Healthcare - Long Beach, CA

Job Description Plan, design, and implement Multi Cloud network systems, including configurations and support. Independently troubleshoot network issues and investigate underlying problems. Coordinate with vendors for the installation of required items, to include Cisco Routers, Switches and Firewalls. Evaluate and implement changes in conjun...

Lead Analyst, Appeals & Grievances

Molina Healthcare - Long Beach, CA

Job Description Job Summary Researches and documents Medicaid and Medicare Advantage denial determinations all levels of reconsiderations/appeals in a thorough, professional and expedient manner. May include evaluation for medical necessity and appropriate levels of care. Knowledge/Skills/Abilities • Serves as team lead for a small group of employe...

Director, Marketplace Distribution

Molina Healthcare - Long Beach, CA

Job Description Job Summary Responsible for establishing, developing and implementing Marketplace outreach/enrollment/retention organic growth initiatives on a regional basis by partnering and providing the Directors of Community Outreach within regional designation. Develop strategies to assist the Director meet growth targets for the health plan. Responsible for ...

Sr Specialist, Provider Contracts

Molina Healthcare - Long Beach, CA

Job Description Responsible for accurate and timely maintenance of critical provider information on the Apttus Contract Lifecycle Management provider database. Publish reports. Duties and Responsibilities: • Initiates, generates and track contract activity within Apttus Contract Lifecycle Management system. • Contract and clause creation and maintenance within t...

Clinical Services Trainer

Molina Healthcare - Long Beach, CA

Knowledge/Skills/Abilities Provides standardized training programs for plan staff to improve quality, control medical costs and ensure compliance with state and federal regulations and guidelines. Responsible for the development and implementation of training curriculum for Utilization Management, Case Management, and LTSS staff. • Responsible for evaluation of training ...

Supervisor, Health Plan Pharmacy Ops

Molina Healthcare - North Charleston, SC

Job Description Job Summary Molina Pharmacy Services/Management staff work to ensure that Molina members have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal ...

Supv, Member Services

Molina Healthcare - Irving, TX

Job Description Job Summary Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.

Lead, Call Center

Molina Healthcare - Irving, TX

Job Description Job Summary Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.

Capacity Planner

Molina Healthcare - Irving, TX

Knowledge/Skills/Abilities Develop and deploy workforce management strategies nationwide. Partner with leaders by strategically identifying business needs, and propose solutions in line with the needs of our members and providers. Requires contact center experience with in-depth Workforce Management experience specializing in planning efforts. Ensures the right numbers of skill...