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Jobs at Molina Healthcare

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RN Case Manager, PRC Program

Molina Healthcare - Bothell, WA

Job Description This is a specialized Case Manager role, focused on Molina members potentially qualified to be enrolled in the State PRC Program (Patient Review & Coordination), as set by the WAC (Washington Administrative Code), in order to reduce or eliminate misuse of Medicaid/State resources. Job Summary Molina Healthcare Services (HCS) works with members, prov...

Director, Provider Contracts

Molina Healthcare - Albuquerque, NM

Knowledge/Skills/Abilities Plans, organizes, staffs, and coordinates the Provider Contracts activities for the state health plan. Works with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider contracts and contracting strategies. • Monitors and reports network adequacy for Medicare and Medicaid services. • In ...

Provider Services Manager

Molina Healthcare - Albuquerque, NM

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...

Compliance Auditor

Molina Healthcare - Long Beach, CA

Job Description Job Summary Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Car...

Compliance Auditor

Molina Healthcare - Long Beach, CA

Job Description Job Summary Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Car...

Case Manager (RN)

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...

Care Review Clinician, Prior Authorization Nurse

Molina Healthcare - Jackson, MS

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...

Manager, Healthcare Analytics

Molina Healthcare - Oak Brook, IL

Job Description Job Summary Collects, validates, analyzes, and organizes data into meaningful reports for management decision making as well as designing, developing, testing and deploying reports to provider networks and other end users for operational and strategic analysis. Knowledge/Skills/Abilities Manages and provides direct oversight of Heal...

Director, National Provider Contracting (REMOTE)

Molina Healthcare - Tampa, FL

Job Description Job Summary Molina's Provider Contracting function provides guidance, signature support services, standards and resources to help Molina Healthcare successfully establish and maintain distinct high performing networks of compassionate and culturally sensitive providers who: • Are aligned with our mission to provide quality health services to fina...

Assoc Rep, Provider InquiryR&R

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...

Specialist, Appeals & Grievances

Molina Healthcare - Long Beach, CA

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

Care Review Clinician, Inpatient Review (RN)

Molina Healthcare - San Antonio, 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...

Pharmacy Technician

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 ...

Sr Claims Examiner

Molina Healthcare - Troy, MI

Job Description Job Summary Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards. Knowledge/Skills/Abilities • Meets and consistently maintains production standards for Claims A...

Chief Medical Officer, Health Plan

Molina Healthcare - Midvale, UT

Knowledge/Skills/Abilities • Provides leadership to the health plan in the areas of strategic planning, strategy execution and implementation of care management programs, including such programs as Quality Improvement, Utilization Management, Care Management, Predictive Modeling, and Disease Management. • Leads the health plan's analysis of medical care cost and utilization ...