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Jobs at Molina Healthcare

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Analyst, Provider Configuration-Quality

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 o...

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 o...

Assoc Analyst, Provider Config

Molina Healthcare - Troy, MI

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 o...

Director, Medical Economics

Molina Healthcare - Long Beach, CA

Job Description Job Summary Responsible for leading the Medical Economics team to develop SAI (Scorable Action Items – Medical Expense Initiatives) tracking tools in conjunction with SAI leads to support of Health Plans data management needs. Collaborates with senior leadership to identify opportunities to improve the Health Plan's performance and data management.

Coordinator, Health Plan Credentialing

Molina Healthcare - Columbus, OH

Job Description Job Summary Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria in order to minimize liability to the company and to maximize safety for members. Knowledge/Skills/Abilities Responsible for coordinating assigned provider creden...

Sr Engineer, (Cloud Security Engineer)

Molina Healthcare - Long Beach, CA

Job Description Sr. Cloud Security Engineer Job Summary Builds company specific systems and technology expertise across multiple infrastructure and development disciplines Knowledge/Skills/Abilities Determine operational feasibility by evaluating analysis, problem definition, requirements, solution development and propos...

Clinic Front Desk Clerk

Molina Healthcare - Everett, WA

Job Description Job Summary Provides support to the clinic operations by adding assistance when applicable. Helps ensure satisfaction is achieved for patients. Knowledge/Skills/Abilities • Assists with requests of medical records. • Ensures medical information and PHI are appropriately approved utilizing clinic information systems. • Assists ...

Specialist, Quality Interventions/QI Compliance

Molina Healthcare - Bothell, WA

Job Description Job Summary Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activitie...

Provider Contracts Manager-Behavioral Health

Molina Healthcare - Bothell, WA

Job Description Job Summary Negotiates agreements with highly visible providers who are strategic to the success of the Plan, including integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers. Knowledge/Skills/Abilities • In conjunction with Director/Manager Provider Contracts...

Case Manager, LTSS

Molina Healthcare - Columbus, OH

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 Engineer, Applications

Molina Healthcare - Long Beach, CA

Job Description – Sr. Engineer, Applications 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 t...

Sr. Abstractor, HEDIS/Quality Improvement

Molina Healthcare - Oak Brook, IL

Job Description Job Summary Molina's Quality Improvement Sr. Abstraction team functions to conduct data collection and abstraction of medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The abstraction team will meet chart abstraction productivity standards as well as minimum over read standards. Knowledge/Skills/Abil...

Assoc Rep, Provider Appeals

Molina Healthcare - Bothell, WA

Job Description Job Summary Molina Health Plan Operations jobs are responsible for the development and administration of our State health plan's operational departments, programs and services, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provid...

RN Clinical Services Auditor (Remote in WA)

Molina Healthcare - North Charleston, SC

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 and p...

AVP, Regional Compliance

Molina Healthcare - Long Beach, CA

Job Description Job Summary The Regional Compliance AVP (RCAVP) shall have, for a select region of health plans, direct oversight and management of both health plan compliance officers and the health plan compliance programs (collectively “compliance activities”). These compliance activities shall be focused on the Medicaid and Marketplace lines of business and, to...