Company Detail

Job Description

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.

• Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.

• Processes requests within required timelines.

• Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.

• Requests additional information from members or providers in consistent and efficient manner.

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

• Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements:

IL Qualifications: Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

Recent hospital experience in ICU, Medical, or ER unit.

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $23.76 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This is a remote position and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This is a remote position and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This is a remote position and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.

• Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.

• Processes requests within required timelines.

• Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.

• Requests additional information from members or providers in consistent and efficient manner.

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

• Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements:

IL Qualifications: Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

Recent hospital experience in ICU, Medical, or ER unit.

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $23.76 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This is a remote position and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This is a remote position and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This is a remote position and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This is a remote position and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.

• Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.

• Processes requests within required timelines.

• Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.

• Requests additional information from members or providers in consistent and efficient manner.

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

• Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements:

IL Qualifications: Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

Recent hospital experience in ICU, Medical, or ER unit.

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $23.76 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This is a remote position and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

Responsible for continuous quality improvements regarding member engagement and member retention. Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the development/maintenance of Member Materials.

Knowledge/Skills/Abilities

- Maintains confidential telephone line to provide direct assistance to Members and/or family members who are unable to resolve their issues or complaints individually. Serves as an advocate in working with providers, regulatory agencies, outside agencies, co-workers and other departments as appropriate. Conducts in person meetings with Members and/or family members as appropriate. Logs all cases in a database.

- Assists members in the complaint and appeal process. Determines the nature of the member's needs or problem; informs members of their rights in the complaints and appeals process; and advises/refers as appropriate for investigation and resolution.

- Conducts focus groups in service delivery area as needed to ensure member needs are being addressed.

- Educates members on covered services available to them, including preventive services.

- Participates in annual member complaints and appeals training with health plan, including the member advocate/engagement role..

Job Qualifications

Required Education

High School diploma.

Required Experience

2 years experience in customer service, consumer advocacy, and/or health care systems. Experience conducting intake, interviews, and/or research of consumer or provider issues. Basic understanding of managed healthcare systems and mental health issues.

Required License, Certification, Association

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

Associate's or Bachelor's Degree in Social Work, Human Services or related field.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $13.41 - $29.06 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

The AVP, Quality & Risk Adjustment is responsible for leading health plan execution for Risk Adjustment and Quality for all lines of business, ensuring alignment of strategy and activities with Enterprise, acting as the Risk Adjustment and Quality subject matter expert for the health plan. The AVP leads a plan with a large membership base, large population, and multiple lines of business. The plan has complex state requirements.

Work Location - Ohio

Job Duties

• Serves as the primary contact to State agencies for all Risk and Quality matters.

• Leads the local Quality committees.

• Prepares, in collaboration and support with MHI Quality, required documentation for state Performance Improvement Projects.

• Aligns with Enterprise the design, implementation, and monitoring the effectiveness of a comprehensive Risk and Quality intervention strategy, acting as a critical stakeholder in establishing the strategic direction from the interventions Joint Operations Committee.

• Collaborates with the MHI RQES teams for Risk and Quality Interventions supporting analytics and strategic teams to develop, present and evaluate intervention strategies.

• Collaborates with MHI Quality for accreditation activities.

• Key stakeholder to MHI RQES for planning and implementing evidence-based quality intervention strategies and initiatives that meet state and federal intervention rules and are aligned with effective practices as identified in the healthcare quality improvement literature and within Molina strategic plans.

• Serves as operations and implementation lead for local execution of Molina plan quality improvement activities.

• Communicates with leadership about key deliverables, timelines, barriers and escalated issues that need immediate attention.

• Communicates and partners with MHI RQES and Plan Network leadership to support establishing QI benchmarks and requirements for VBC contracts.

• Responsible for partnering with MHI RQES and VP Stars in developing the local Medicare Stars work plan and executes on interventions that will improve CAHPS, HEDIS and HOS scores. Responsible for monitoring Part D and Operational health insurance metrics and coordinating with centralized teams to improve these metrics.

• Responsible for partnering with MHI RQES and VP Stars in managing MMP quality withhold revenue in MMP States. Supports development of interventions and a local strategy to improve withhold revenue earned to meet or exceed budgeted goals.

• Collaborates with MHI risk and quality analytics for broad-based quality data analytics. Key stakeholder in efforts to develop broad-based risk and quality data analytics to support ongoing, real-time, local VBC contract requirements using both MHI RQES and local resources.

• Supports MHI HEDIS Operations to do majority of HEDIS abstractions. Oversees Health Plan local resources to facilitate local clinical data acquisition for abstraction for required VBC customized reports to meet VBC network contract obligations not supported by the national MHI team.

• Presents summaries, key takeaways and action steps about Molina risk and quality strategy to national, regional and plan meetings. Leads and influences cross-functional teams that oversee implementation of risk and quality interventions. Functions as local leader for intervention for qualitative and quantitative analysis, expected ROI analysis, key performance indicator development, reporting and development of program materials, templates or policies.

• Serves as a member of the State's Provider Engagement team for large, contracted, value-based provider systems.

• Attends state and regional Quality Improvement and/or Board of Directors Meetings and representing the Health Plan. Represents Molina in external forums, presents Molina's risk and quality results, and serves as the external risk and quality expert and emissary in statewide conferences and collaborative.

Job Qualifications

REQUIRED EDUCATION :

Bachelor's Degree in a related field (Healthcare Administration, RN, Public Health, or equivalent experience)

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

• Minimum 10 years experience in quality compliance/HEDIS operations, customer service or provider service in a managed care setting with previous leadership experience to include managing people, project management, team building, and experience developing performance measures that support business objectives.

• Strong knowledge in risk and quality in order to implement effective interventions that drive change.

• Ability to inspire and work directly with external providers to advance Molina's Value-based quality initiatives.

• Ability to collaborate and educate network providers to develop effective practice-based quality improvements.

• Deep knowledge of Quality Discipline including metrics and performance standards. Working knowledge of Risk Adjustment. Project management experience, in a managed healthcare setting.

PREFERRED EXPERIENCE :

• 10+ years experience in managed healthcare administration

• 10+ years experience in a Quality leadership role with a Managed Care Payer with experience in all lines of business

• 3-5 years of Risk Adjustment experience

• CPHQ Certificate

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $122,430.44 - $238,739.35 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This is a remote position and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This is a remote position and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This position will be remote and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This position will be remote and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This position will be remote and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This position will be remote and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

This remote position will be supporting the Washington & New Mexico markets and employees can be located anywhere in the US

Job Summary

The Sr Auditor, Delegation Oversight will independently perform audits of multi-delegated functions with minimal oversight and expertise in at least one functional area of auditing. Ensures continuous compliance with Program Integrity requirements (e.g., Monitoring of Exclusion Databases, and Mandatory Employee Trainings) of Molina Health Plan, NCQA, CMS and State Medicaid entities.

Job Duties

• Oversees Utilization Management, Claims, Organizational Credentialing, and Crisis Call Center delegated activities.

• Leads and performs pre-delegation, annual audits, ensuring all components of audit activities comply with NCQA, State and Federal requirements

• Lead external collaborative with other agencies in providing oversight of Behavioral Health Administrative Service Organization for monitoring and auditing of Crisis Lines, Utilization Management, and Organizational Credentialing.

• Ensure that all external partners in the collaborative are assigned to BHASO audits and are completing audits timely.

• Conducts focused audits on subcontractors, as applicable, documenting the outcomes and making recommendations as necessary for further action.

• Conducts analysis of audit issues to identify root cause, develop and issue corrective action plans.

• Build and grow internal and external partnerships to continue team approach to delegate support.

• Prepares, tracks and provides audit reports in accordance with departmental requirements.

• Prepare, submit and present audit reports to Delegation Oversight Committees.

• Presents audit findings to subcontractors and makes recommendations for improvements based on audit results.

• Works with Delegation Oversight Management to develop and maintain assessment tools.

• Update delegates on all Contracting, Federal and State guidelines related to their delegated responsibilities

• Complete all mandatory compliance training annually or as required by leadership.

Job Qualifications

REQUIRED EDUCATION : Bachelor's Degree or equivalent, combination of education and experience

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

• Minimum three years Delegation Oversight experience.

• Minimum two year auditing or utilization review experience.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $49,430.25 - $107,098.87 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This position will be remote and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This position will be remote and employee can reside anywhere in the US

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.

• Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.

• Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes.

• Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance.

• Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement.

• Assists in the development and implementation of internal desktop processes and procedures.

• Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers.

JOB QUALIFICATIONS

Required Education

High School Diploma or equivalent GED

Required Experience

• 2+ years' experience in an administrative support role in healthcare, Medical Assistant

• Strong communication skills

• Strong analytic and problem-solving abilities

Preferred Education

Associate's or bachelor's degree

Preferred Experience

• 1+ years of supervisory experience

• 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

For this position we are seeking a (RN) Registered Nurse who lives in VIRGINIA and must be licensed for the state of VIRGINIA.

Director will support a team Managers who all manage a case load of field Nurse Case Managers supporting our LTSS Medicaid program We are looking for someone with strong leadership and experience with direct reports. Previous MCO experience is strongly preferred with LTSS experience.

This is a remote position that will allow you to anywhere within the state of VA.

Must be able to commute to Richmond VA office for leadership meetings when needed.

Home office with internet connectivity of high speed required.

Core Business hours are Monday - Friday 8 AM to 5 PM EST (Flexibility is needed to support team)

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Knowledge/Skills/Abilities

- Directs the health plan's implementation, monitoring and integration of Long-Term Supports and Services (LTSS), including Adult Day Healthcare, Personal Care Assistance, Home and Community-based Waivers (HCBS), and Community Transition/Money Follows the Person.

- Operationalizes the Plan's LTSS responsibilities and oversight delineated in the State-specific Memorandum of Understanding (MOU) or Contract Scope of Work

- Collaborates with County and community-based organization leadership

- Participates in County advisory groups and liaises with consumer advocacy organizations, members, caregivers (as appropriate) and other community-based organizations (CBOs) to ensure program integrity and identify areas for development.

- Monitors and reports on quality and outcome measures that align with the Molina clinical and social model of care and the State LTSS program goals as stated in MOU or Contract

- Develops policies and procedures that provide health plan guidance on integrated services and the incorporation of LTSS into individualized care plan development.

- Provides oversight of all clinical management functions for LTSS programs including but not limited to: adherence to State and Federal contracts; assessment; service planning; care coordination; transition planning, and participant and caregiver education and training.

- Identifies needs for process changes and training to better serve members and adhere to both Molina model of care goals, regulatory requirements, and enterprise standardization.

- Participates in the recruitment and hiring of LTSS staff with appropriate skills and experience.

- 25-35% local travel required..

Job Qualifications

Required Education

Bachelor's Degree in Public Health, Public Policy, Health Administration, Gerontology, Social Work, or related field

and/or relevant experience in lieu of clinical experience required.

Required Experience

- Min. 5 years health care management experience, including State Medicaid LTC (both institutional and home and community based).

- Experience creating interpretive guidelines and program development.

- Proven ability to set and achieve aggressive program objectives and goals.

- Proven ability to implement an effective monitoring program to include providing constructive criticism and requiring acceptable corrective action plans.

- Management of professional and non-professional staff.

- 3-5 years health care information systems experience.

Required License, Certification, Association

Active and unrestricted applicable State-Licensed Nurse, Licensed Independent Social Worker (LISW), or has Master's Degree in Nursing, Healthcare, Social Work, Gerontology or other healthcare field.

Preferred Education

Master's Degree in Nursing, Healthcare, Social Work, Gerontology or other healthcare field preferred.

Preferred Experience

N/A

Preferred License, Certification, Association

N/A

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $79,607.91 - $172,483.8 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

This position will be supporting our Washington State Medicare plan. We are seeking a candidate with previous Case Management experience and a WA LCSW or LCISW licensure. Medicare knowledge/experience is highly preferred. Proficient knowledge of MS Suite is very helpful. The Case Manager must be able to work in a high-volume environment. Further details to be discussed during our interview process.

Remote: some light travel may required based on the members need.

Work schedule Monday through Friday 8:30 AM to 5:00 PM PST.

WA LCSW or LCISW licensure required.

KNOWLEDGE/SKILLS/ABILITIES

• Completes clinical assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers from the assessment.

• Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Conducts telephonic, face-to-face or home visits as required.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Maintains ongoing member case load for regular outreach and management.

• Promotes integration of services for members including behavioral health care and long term services and supports to enhance the continuity of care for Molina members.

• May implement specific Molina wellness programs i.e. asthma and depression disease management.

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.

• Assesses for barriers to care, provides care coordination and assistance to member to address concerns.

• Collaborates with RN case managers/supervisors as needed or required

• Case managers in Behavioral Health and Social Science fields may provide consultation, resources and recommendations to peers as needed

• Local travel of up to 40% may be required, depending on the complexity level of the assigned members, particular state-specific regulations, or whether the Case Manager position is located within Molina's Central Programs unit.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Any of the following:

Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or Master's Degree (preferably in a social science, psychology, gerontology, public health or social work or related

REQUIRED EXPERIENCE:

1-3 years in case management, disease management, managed care or medical or behavioral health settings.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

If license required for the job, license must be active, unrestricted and in good standing.

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

STATE SPECIFIC REQUIREMENTS:

Roles serving Family Care and Family Care Partnership in the State of Wisconsin are required to have a Bachelor's Degree and a minimum of one year of professional experience.

PREFERRED EXPERIENCE:

3-5 years in case management, disease management, managed care or medical or behavioral health settings.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Any of the following:

Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Case Manager (CCM), Certified in Health Education and Promotion (CHEP), Licensed Professional Counselor (LPC/LPCC), Respiratory Therapist, or Licensed Marriage and Family Therapist (LMFT).

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJHS

#LI-AC1

Pay Range: $21.6 - $46.81 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

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 desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

This position will be supporting our Washington State Medicare plan. We are seeking a Registered Nurse with previous Case Management experience. Medicare knowledge/experience is highly preferred. Proficient knowledge of MS Suite is very helpful. The Case Manager must be able to work in a high-volume environment conducting telephonic outreaches and Care Plan creation for our members. Further details to be discussed during our interview process.

Remote; must reside in Washington State. Some travel may be required based on members need.

WA state RN licensure required.

Work schedule Monday through Friday 8:30 AM to 5:00 PM PST.

KNOWLEDGE/SKILLS/ABILITIES

• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment.

• Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Conducts face-to-face or home visits as required.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Maintains ongoing member case load for regular outreach and management.

• Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for Molina members.

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.

• Assesses for barriers to care, provides care coordination and assistance to member to address concerns.

• 25- 40% local travel required.

• RNs provide consultation, recommendations and education as appropriate to non-RN case managers.

• RNs are assigned cases with members who have complex medical conditions and medication regimens

• RNs conduct medication reconciliation when needed.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

1-3 years in case management, disease management, managed care or medical or behavioral health settings.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

3-5 years in case management, disease management, managed care or medical or behavioral health settings.

Preferred License, Certification, Association

Active, unrestricted Certified Case Manager (CCM)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJHS

#LI-AC1

Pay Range: $23.76 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare