Company Detail

Job Description

JOB DESCRIPTION

Family Care with My Choice Wisconsin

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

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service 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.

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

• 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.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

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

• Facilitates interdisciplinary care team meetings for approval or denial of services 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 psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background

REQUIRED EXPERIENCE:

• At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports.

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

PREFERRED EXPERIENCE:

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

• 1 year experience working with population who receive waiver services.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing

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

STATE SPECIFIC REQUIREMENTS:

For the state of Wisconsin:

Bachelor's degree or more advanced degree in the human services area and a minimum of one (1) year experience working with at least one of the Family Care target populations; or

Bachelor's degree or more advanced degree in any area other than human services with a minimum of three (3) years' experience working with at least one of the Family Care target populations.

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

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

Employees for this role will work remotely 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

Employees for this role will work remotely 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

Job Summary

The Care Connections Representative primary focus is to conduct outbound calls to Molina members and schedule appointments with our Nurse Practitioners. As part of Molina's benefit package, the appointments are for preventive care services delivered in the home, community, and nursing facility settings.

Job Duties

• Conduct outbound calls to Molina members and schedule appointments with our Nurse Practitioners

• Understands and strives to meet or exceed call center metrics while providing high quality consistent customer service

• Removes barriers for member's, escalating high impact member issues

• Perform timely documentation in electronic medical record and provide daily audits and feedback

• Accurately schedule appointments to meet all key metrics based on individual scripts, Care Connections, state, and company goals,

• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

• Participate in special projects as assigned

• Other duties as assigned

JOB QUALIFICATIONS

Required Education

• High School Diploma or equivalency

Required Experience/Knowledge/Skills/Abilities

• Excellent customer service, active listening, verbal and written communication skills, professional phone voice.

• Working knowledge of Microsoft Office (Outlook, Word, Excel) or other comparable software

• Strong phone and verbal communication skills along with active listening

• Ability to multi-task, set priorities, high ability to pivot with change in strategy and manage time effectively.

• Problem solving skills.

• Attention to detail.

• Bilingual (English/Spanish, Chinese, Korean or Vietnamese)

Preferred Education

• Associate's degree or equivalent combination of education and experience

Preferred Experience

• Customer Service/Call Center experience in health care or equivalent related

• Experience doing outbound appointment setting or similar services

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

Pay Range: $12.19 - $26.42 / 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

Lead Systems Analyst, TCIM - Tech Support, Data Analytics, Emerging technologies

Job Description

The Technical Systems Analyst will be responsible for the design and development of moderate to complex SSIS solutions. Additionally, this role will require the development of automated operational reports and dashboards utilizing Power BI and SQL Server Reporting Services. The position requires three-five years' experience with tools and systems utilizing the Microsoft SQL BI Stack including SSIS, SSRS, TSQL, Power Query, MDX, PowerBI, and DAX. The role is also slated to help understand, design, research and work on emerging technologies.

Knowledge/Skills/Abilities

• Strong knowledge of SQL Server, SSIS and t-SQL, preferably on Azure and/or SQL 2016+ Proven ability to architect and develop solutions which perform data transformations using Microsoft SSIS/SQL ETL tools

• Design and develop SQL Server stored procedures, functions, views and triggers

• Design, implement and maintain SQL database objects (tables, views, indexes) and database security

• Debug and tune existing SSIS/ETL processes to ensure accurate and efficient movement of processed data

• Design, develop and maintain reports and dashboards in Power BI and SQL Server Reporting Services (SSRS).

• Ability to author reports having multiple data sources, complex queries, views, stored procedures, and automation features.

• Assist with database performance optimization and interoperability issues

• Collaborate with Product Owners to elicit and document business requirements for ETL and report design.

• Ability to translate business requirements into sound technical specifications

• Research issues and sets up proof of concept tests

• Support quality acceptance testing which includes the development and/or refinement of test plans

• Lead design review session with scrum team to validate requirements

• Troubleshoot data quality issues and defects to determine root cause

• Strong knowledge of writing BRD's.

• 5+ years software development experience with 3+ years SQL programming utilizing SSIS/SSRS and Power BI

• Experience working with Azure SQL Database, DevOps, GIT and Continual Integration (CI)

• Knowledge and/or experience of the Agile framework and working in a scrum team

• Basic to intermediate knowledge of C#

• Familiarity with healthcare data and concepts

• Familiarity with QNXT

• Excellent analytical and problem-solving abilities

• Strong written and oral communication skills

• Must be able to coach and mentor junior resources within the team.

Required Education

• Bachelor's Degree or equivalent combination of education and 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: $65,791.66 - $142,548.59 / 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

Supporting the OH Plan, the candidate will act as a liaison to our state regulator on Encounters as well as lead various other technical programs under the OH Operations Department. These currently include support of provider data requirements, vendor data interfaces, Ohio Dept of Medicaid data interfaces, and be a technical resource that can liaison between OH Operations Dept and IT teams. Must be a self-starter willing to learn. Must be a good communicator, comfortable speaking up in group discussions and love work collaboratively with other teams and with senior leadership. This role involves research, root cause analysis, sharing recommendations, analyzing reports and other duties as specified.

Analyzes complex business problems and issues using member, provider, claims, and encounter data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Develops, implements and uses software and systems to identify issues in data sourced from state and federal agencies and loaded to internal systems.

• Identify data trends.

• Good knowledge of EDI X12 Transactions such as 834, 835, 837, etc.

• Uses comprehensive background to navigate analytical problems, including clearly defining and documenting their unique specifications.

• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

• Responsible for developing appropriate methodologies and preparation of weekly reports.

• Encourages cooperative interactions between cross functional teammates.

• Coordinates work of other business data analysts and provides training to subordinates/team members.

• Leverages expertise to review, research, analyze and evaluate all data relating to specific area of expertise.

• Actively leads in all stages of project development including research, design, programming, testing and implementation to ensures the released product meets the intended functional and operational requirements

• Uses mastery of subject matter to guide communication and collaboration with external and internal customers by analyzing their needs and goals.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

• 7+ years of business analysis experience,

• 6+ years managed care experience.

• Demonstrates expertise in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

• 6+ years experience working as a data or business analyst

• Experienced in developing ad-hoc and standard reports using SQL and Azure Databricks or similar tools to perform analysis on member enrollment data

• Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.

Preferred License, Certification, Association

QNXT or similar healthcare payer applications

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: $59,810.6 - $129,589.63 / 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

Supporting the OH Plan, the candidate will act as a liaison to our state regulator on Encounters as well as lead various other technical programs under the OH Operations Department. These currently include support of provider data requirements, vendor data interfaces, Ohio Dept of Medicaid data interfaces, and be a technical resource that can liaison between OH Operations Dept and IT teams. Must be a self-starter willing to learn. Must be a good communicator, comfortable speaking up in group discussions and love work collaboratively with other teams and with senior leadership. This role involves research, root cause analysis, sharing recommendations, analyzing reports and other duties as specified.

Analyzes complex business problems and issues using member, provider, claims, and encounter data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Develops, implements and uses software and systems to identify issues in data sourced from state and federal agencies and loaded to internal systems.

• Identify data trends.

• Good knowledge of EDI X12 Transactions such as 834, 835, 837, etc.

• Uses comprehensive background to navigate analytical problems, including clearly defining and documenting their unique specifications.

• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

• Responsible for developing appropriate methodologies and preparation of weekly reports.

• Encourages cooperative interactions between cross functional teammates.

• Coordinates work of other business data analysts and provides training to subordinates/team members.

• Leverages expertise to review, research, analyze and evaluate all data relating to specific area of expertise.

• Actively leads in all stages of project development including research, design, programming, testing and implementation to ensures the released product meets the intended functional and operational requirements

• Uses mastery of subject matter to guide communication and collaboration with external and internal customers by analyzing their needs and goals.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

• 7+ years of business analysis experience,

• 6+ years managed care experience.

• Demonstrates expertise in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

• 6+ years experience working as a data or business analyst

• Experienced in developing ad-hoc and standard reports using SQL and Azure Databricks or similar tools to perform analysis on member enrollment data

• Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.

Preferred License, Certification, Association

QNXT or similar healthcare payer applications

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: $59,810.6 - $129,589.63 / 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

The Care Connections Representative primary focus is to conduct outbound calls to Molina members and schedule appointments with our Nurse Practitioners. As part of Molina's benefit package, the appointments are for preventive care services delivered in the home, community, and nursing facility settings.

Job Duties

• Conduct outbound calls to Molina members and schedule appointments with our Nurse Practitioners

• Understands and strives to meet or exceed call center metrics while providing high quality consistent customer service

• Removes barriers for member's, escalating high impact member issues

• Perform timely documentation in electronic medical record and provide daily audits and feedback

• Accurately schedule appointments to meet all key metrics based on individual scripts, Care Connections, state, and company goals,

• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

• Participate in special projects as assigned

• Other duties as assigned

JOB QUALIFICATIONS

Required Education

• High School Diploma or equivalency

Required Experience/Knowledge/Skills/Abilities

• Excellent customer service, active listening, verbal and written communication skills, professional phone voice.

• Working knowledge of Microsoft Office (Outlook, Word, Excel) or other comparable software

• Strong phone and verbal communication skills along with active listening

• Ability to multi-task, set priorities, high ability to pivot with change in strategy and manage time effectively.

• Problem solving skills.

• Attention to detail.

• Bilingual (English/Spanish, Chinese, Korean or Vietnamese)

Preferred Education

• Associate's degree or equivalent combination of education and experience

Preferred Experience

• Customer Service/Call Center experience in health care or equivalent related

• Experience doing outbound appointment setting or similar services

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

Pay Range: $12.19 - $26.42 / 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 Member Navigator primary function is to be the member's liaison. Primarily telephonic, this role is responsible for ensuring that the members member has assistance they may need in navigating their health care needs. Throughout the duration of services, the Member Navigator will communicate with members and caregivers to uncover and act on possible barriers to a healthy outcome, thereby safeguarding against unnecessary admissions, readmissions, urgent care, and emergency department visits.

KNOWLEDGE/SKILLS/ABILITIES

• Strong working knowledge of medical terminology and healthcare landscape preferred

• Excellent written and verbal communication skills to collaborate internally and externally with members, providers, team members, and manager

• Work in an independent manner with minimum supervision

• Excellent problem solving, critical thinking, and organizational skills

• Must be organized and able to prioritize, plan, and handle multiple tasks simultaneously

• Serve as the member's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures

• Make all member welcome calls on date of notification of assignment and/or discharge. Make appropriate and timely member appointments, confirmations, and appointment reminders. Mail letters as needed

• Complete telephonic visits with members utilizing current standard operating procedures

• Notify all appropriate departments of data related member case updates

• Outreach to members/members providers and input appointments

• Adhere to established guidelines for case closings

• Identify and connect member to resources for addressing Social Determinants of Health (SDOH) by utilizing resources from the Health Plan and Aunt Bertha

• Outreach to the appropriate party to report any benefit, authorization, claim or eligibility related issue

• Prepare information for member case status summaries, success stories, etc. and participate in daily huddles, weekly meetings, and other scheduled events, internally, and with members externally

• Prepare, communicate, and follow through on member issues that require escalation communications to management

• Conduct and collaborate on creating action plans for member barriers

• Review system related tasks and email instructions throughout the day for management of daily responsibilities to manage all assigned member cases effectively and thoroughly to completion

• Maintain member outreach and daily activities for cases assigned to out of office Member Navigators and peers as directed by leadership team

• Document accurately all phone calls, interventions, appointments and other system related data member concerns, questions, or complaints

• Consistently meet position Key Performance Indicator metrics as defined by leadership

• Other duties as assigned by leadership may exist to meet business needs.

• Bilingual (English/Spanish, Vietnamese, Chinese)

JOB QUALIFICATIONS

Required Education

High School Diploma or GED required

Required Experience

2+ years of customer service and/or healthcare experience in a fast-paced environment

Preferred Education

Associate Degree or higher from an accredited college preferred

Preferred Experience

• Computer proficiency to include typing, data entry, internet research, and spelling accuracy

• Proficient with Microsoft Office applications including Word, Excel and PowerPoint

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.

#PJCorp

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

Lead Systems Analyst, TCIM - Tech Support, Data Analytics, Emerging technologies

Job Description

The Technical Systems Analyst will be responsible for the design and development of moderate to complex SSIS solutions. Additionally, this role will require the development of automated operational reports and dashboards utilizing Power BI and SQL Server Reporting Services. The position requires three-five years' experience with tools and systems utilizing the Microsoft SQL BI Stack including SSIS, SSRS, TSQL, Power Query, MDX, PowerBI, and DAX. The role is also slated to help understand, design, research and work on emerging technologies.

Knowledge/Skills/Abilities

• Strong knowledge of SQL Server, SSIS and t-SQL, preferably on Azure and/or SQL 2016+ Proven ability to architect and develop solutions which perform data transformations using Microsoft SSIS/SQL ETL tools

• Design and develop SQL Server stored procedures, functions, views and triggers

• Design, implement and maintain SQL database objects (tables, views, indexes) and database security

• Debug and tune existing SSIS/ETL processes to ensure accurate and efficient movement of processed data

• Design, develop and maintain reports and dashboards in Power BI and SQL Server Reporting Services (SSRS).

• Ability to author reports having multiple data sources, complex queries, views, stored procedures, and automation features.

• Assist with database performance optimization and interoperability issues

• Collaborate with Product Owners to elicit and document business requirements for ETL and report design.

• Ability to translate business requirements into sound technical specifications

• Research issues and sets up proof of concept tests

• Support quality acceptance testing which includes the development and/or refinement of test plans

• Lead design review session with scrum team to validate requirements

• Troubleshoot data quality issues and defects to determine root cause

• Strong knowledge of writing BRD's.

• 5+ years software development experience with 3+ years SQL programming utilizing SSIS/SSRS and Power BI

• Experience working with Azure SQL Database, DevOps, GIT and Continual Integration (CI)

• Knowledge and/or experience of the Agile framework and working in a scrum team

• Basic to intermediate knowledge of C#

• Familiarity with healthcare data and concepts

• Familiarity with QNXT

• Excellent analytical and problem-solving abilities

• Strong written and oral communication skills

• Must be able to coach and mentor junior resources within the team.

Required Education

• Bachelor's Degree or equivalent combination of education and 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: $65,791.66 - $142,548.59 / 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

Employees for this role will work remotely 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

Opportunity open to TX RN in the West Forth Worth service delivery area to work as a Field Case Manager with our Medicaid members there. The schedule is Monday - Friday, 8 AM - 5PM CST. Part of the responsibilities of the role is to conduct face-to-face meetings with the members in their homes, completing assessments needed for determining the types of services we need to provide. Preference will be given to those candidates with previous LTSS experience. Mileage is reimbursed as part of our benefits package.

The service area includes the following zip codes (and preference will be given to qualified candidates who reside in one): 76109, 76116, 76110, 76110, 76122, 76164, 76106, 76107. North of I-20 to South of 35/820.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, Teams, and One Note.

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

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service 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.

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

• 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.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

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

• Facilitates interdisciplinary care team meetings for approval or denial of services 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 psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• Provides consultation, recommendations and education as appropriate to non-RN case managers

• Works cases with members who have complex medical conditions and medication regimens

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

• At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports.

• 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 license (RN) in good standing

• If field work is required, 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

Virginia: Must have at least one year of experience working directly with individuals with Substance Use Disorders

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.

• 1 year experience working with population who receive waiver services.

Preferred License, Certification, Association

Active and 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.

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

Job Summary

The Member Navigator primary function is to be the member's liaison. Primarily telephonic, this role is responsible for ensuring that the members member has assistance they may need in navigating their health care needs. Throughout the duration of services, the Member Navigator will communicate with members and caregivers to uncover and act on possible barriers to a healthy outcome, thereby safeguarding against unnecessary admissions, readmissions, urgent care, and emergency department visits.

KNOWLEDGE/SKILLS/ABILITIES

• Strong working knowledge of medical terminology and healthcare landscape preferred

• Excellent written and verbal communication skills to collaborate internally and externally with members, providers, team members, and manager

• Work in an independent manner with minimum supervision

• Excellent problem solving, critical thinking, and organizational skills

• Must be organized and able to prioritize, plan, and handle multiple tasks simultaneously

• Serve as the member's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures

• Make all member welcome calls on date of notification of assignment and/or discharge. Make appropriate and timely member appointments, confirmations, and appointment reminders. Mail letters as needed

• Complete telephonic visits with members utilizing current standard operating procedures

• Notify all appropriate departments of data related member case updates

• Outreach to members/members providers and input appointments

• Adhere to established guidelines for case closings

• Identify and connect member to resources for addressing Social Determinants of Health (SDOH) by utilizing resources from the Health Plan and Aunt Bertha

• Outreach to the appropriate party to report any benefit, authorization, claim or eligibility related issue

• Prepare information for member case status summaries, success stories, etc. and participate in daily huddles, weekly meetings, and other scheduled events, internally, and with members externally

• Prepare, communicate, and follow through on member issues that require escalation communications to management

• Conduct and collaborate on creating action plans for member barriers

• Review system related tasks and email instructions throughout the day for management of daily responsibilities to manage all assigned member cases effectively and thoroughly to completion

• Maintain member outreach and daily activities for cases assigned to out of office Member Navigators and peers as directed by leadership team

• Document accurately all phone calls, interventions, appointments and other system related data member concerns, questions, or complaints

• Consistently meet position Key Performance Indicator metrics as defined by leadership

• Other duties as assigned by leadership may exist to meet business needs.

• Bilingual (English/Spanish, Vietnamese, Chinese)

JOB QUALIFICATIONS

Required Education

High School Diploma or GED required

Required Experience

2+ years of customer service and/or healthcare experience in a fast-paced environment

Preferred Education

Associate Degree or higher from an accredited college preferred

Preferred Experience

• Computer proficiency to include typing, data entry, internet research, and spelling accuracy

• Proficient with Microsoft Office applications including Word, Excel and PowerPoint

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.

#PJCorp

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

Lead Systems Analyst, TCIM - Tech Support, Data Analytics, Emerging technologies

Job Description

The Technical Systems Analyst will be responsible for the design and development of moderate to complex SSIS solutions. Additionally, this role will require the development of automated operational reports and dashboards utilizing Power BI and SQL Server Reporting Services. The position requires three-five years' experience with tools and systems utilizing the Microsoft SQL BI Stack including SSIS, SSRS, TSQL, Power Query, MDX, PowerBI, and DAX. The role is also slated to help understand, design, research and work on emerging technologies.

Knowledge/Skills/Abilities

• Strong knowledge of SQL Server, SSIS and t-SQL, preferably on Azure and/or SQL 2016+ Proven ability to architect and develop solutions which perform data transformations using Microsoft SSIS/SQL ETL tools

• Design and develop SQL Server stored procedures, functions, views and triggers

• Design, implement and maintain SQL database objects (tables, views, indexes) and database security

• Debug and tune existing SSIS/ETL processes to ensure accurate and efficient movement of processed data

• Design, develop and maintain reports and dashboards in Power BI and SQL Server Reporting Services (SSRS).

• Ability to author reports having multiple data sources, complex queries, views, stored procedures, and automation features.

• Assist with database performance optimization and interoperability issues

• Collaborate with Product Owners to elicit and document business requirements for ETL and report design.

• Ability to translate business requirements into sound technical specifications

• Research issues and sets up proof of concept tests

• Support quality acceptance testing which includes the development and/or refinement of test plans

• Lead design review session with scrum team to validate requirements

• Troubleshoot data quality issues and defects to determine root cause

• Strong knowledge of writing BRD's.

• 5+ years software development experience with 3+ years SQL programming utilizing SSIS/SSRS and Power BI

• Experience working with Azure SQL Database, DevOps, GIT and Continual Integration (CI)

• Knowledge and/or experience of the Agile framework and working in a scrum team

• Basic to intermediate knowledge of C#

• Familiarity with healthcare data and concepts

• Familiarity with QNXT

• Excellent analytical and problem-solving abilities

• Strong written and oral communication skills

• Must be able to coach and mentor junior resources within the team.

Required Education

• Bachelor's Degree or equivalent combination of education and 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: $65,791.66 - $142,548.59 / 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

The Care Connections Representative primary focus is to conduct outbound calls to Molina members and schedule appointments with our Nurse Practitioners. As part of Molina's benefit package, the appointments are for preventive care services delivered in the home, community, and nursing facility settings.

Job Duties

• Conduct outbound calls to Molina members and schedule appointments with our Nurse Practitioners

• Understands and strives to meet or exceed call center metrics while providing high quality consistent customer service

• Removes barriers for member's, escalating high impact member issues

• Perform timely documentation in electronic medical record and provide daily audits and feedback

• Accurately schedule appointments to meet all key metrics based on individual scripts, Care Connections, state, and company goals,

• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

• Participate in special projects as assigned

• Other duties as assigned

JOB QUALIFICATIONS

Required Education

• High School Diploma or equivalency

Required Experience/Knowledge/Skills/Abilities

• Excellent customer service, active listening, verbal and written communication skills, professional phone voice.

• Working knowledge of Microsoft Office (Outlook, Word, Excel) or other comparable software

• Strong phone and verbal communication skills along with active listening

• Ability to multi-task, set priorities, high ability to pivot with change in strategy and manage time effectively.

• Problem solving skills.

• Attention to detail.

• Bilingual (English/Spanish, Chinese, Korean or Vietnamese)

Preferred Education

• Associate's degree or equivalent combination of education and experience

Preferred Experience

• Customer Service/Call Center experience in health care or equivalent related

• Experience doing outbound appointment setting or similar services

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

Pay Range: $12.19 - $26.42 / 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 Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, community, and nursing facility settings. Provides needed care in the environment that patients feel most comfortable and are most receptive including home, nursing facilities, and -pop up- clinic.

The Nurse Practitioner will be required to work primarily in non-clinical settings and provide medical care to all levels of patients. Some programs may focus on specific populations (e.g., adult and geriatric, pediatric, women's health).

Perform comprehensive medical assessments, order appropriate tests/procedures for diagnostic purposes, formulate treatment plans, obtain specialists' consultations as needed, and do appropriate documentations as required.

Job Duties

• Provide general medical care and care coordination to various and/or specific patient levels - adults, women's health, pediatric, and geriatric.

• Perform comprehensive evaluations including history and physical exams for gaps in care and preventative assessments

• Address both chronic and acute primary care complaints, and able to ascertain medical urgency

• Establish and document reasonable medical diagnoses

• Seek specialty consultation as appropriate

• Order/perform pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptom; able to work within an environment of limited resources and therefore uses diagnostic tests judiciously and appropriately

• Responsible for knowing when a patient's needs are beyond their scope of knowledge and when physician oversight is needed.

• Create and implements a medical plan of care

• Schedule patient appointments for visits when appropriate

• Provide post discharge coordination to reduce hospital readmission rates and emergency room utilization

• Perform face-to-face in-person visits in a variety of settings including home, skilled nursing facilities, and public locations.

• Additionally, may perform face-to-face visits via alternate modalities based on business need, leadership direction, and state regulations

• Order bulk laboratory orders to target specific populations of member.

• Perform alternating on-call coverage to triage any urgent lab results and pharmacy inquiries and develop appropriate plan of care

• Participate in community-based -Pop Up Clinics- as way of building relationship with community while addressing gaps in health care

• Drive up to 120 miles a day on a regular basis to a variety of locations within the assigned region. There may be drives beyond 120 miles as part of Extended Mileage Special Project days. Special Projects may include an overnight hotel stay.

• Obtain and maintain cross state license in other states besides home state based on business need.

• Collaborate with fellow nurse practitioners to develop best practices to perform work duties efficiently and effectively

• Actively participate in regional meetings

• Prescribe medications and perform procedures as appropriate

• Perform timely documentation in medical records in an electronic medical record computer system

• On occasion, may be required to walk flights of stairs while carrying up to 50 lbs. of equipment

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Master's degree in family health from accredited nursing program

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

Advanced computer skills. Proficient with Word, Excel, and Electronic Medical Record.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

• An active and unrestricted national certification from one of the following organizations: American Academy of Nurse Practitioners; American Nurses Credentialing Center

• Current state-issued license to practice as a Family Nurse Practitioner

• Current Basic Life Support for Healthcare Professional certification

• Current unrestricted driver's license

PREFERRED EDUCATION:

PREFERRED EXPERIENCE:

• 3-5-year experience as a Registered Nurse and/or Nurse Practitioner, ideally in a home health, community health, or public health setting

• Previous experience in home health as a licensed clinician, especially in management of chronic conditions

• Experience with underserved populations facing socioeconomic barriers to health care

• Fluency in a language in addition to English is plus

• Immunization and point of care testing skills

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: $72,370.82 - $156,803.45 / 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

Supporting the OH Plan, the candidate will act as a liaison to our state regulator on Encounters as well as lead various other technical programs under the OH Operations Department. These currently include support of provider data requirements, vendor data interfaces, Ohio Dept of Medicaid data interfaces, and be a technical resource that can liaison between OH Operations Dept and IT teams. Must be a self-starter willing to learn. Must be a good communicator, comfortable speaking up in group discussions and love work collaboratively with other teams and with senior leadership. This role involves research, root cause analysis, sharing recommendations, analyzing reports and other duties as specified.

Analyzes complex business problems and issues using member, provider, claims, and encounter data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Develops, implements and uses software and systems to identify issues in data sourced from state and federal agencies and loaded to internal systems.

• Identify data trends.

• Good knowledge of EDI X12 Transactions such as 834, 835, 837, etc.

• Uses comprehensive background to navigate analytical problems, including clearly defining and documenting their unique specifications.

• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

• Responsible for developing appropriate methodologies and preparation of weekly reports.

• Encourages cooperative interactions between cross functional teammates.

• Coordinates work of other business data analysts and provides training to subordinates/team members.

• Leverages expertise to review, research, analyze and evaluate all data relating to specific area of expertise.

• Actively leads in all stages of project development including research, design, programming, testing and implementation to ensures the released product meets the intended functional and operational requirements

• Uses mastery of subject matter to guide communication and collaboration with external and internal customers by analyzing their needs and goals.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

• 7+ years of business analysis experience,

• 6+ years managed care experience.

• Demonstrates expertise in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

• 6+ years experience working as a data or business analyst

• Experienced in developing ad-hoc and standard reports using SQL and Azure Databricks or similar tools to perform analysis on member enrollment data

• Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.

Preferred License, Certification, Association

QNXT or similar healthcare payer applications

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: $59,810.6 - $129,589.63 / 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

The Care Connections Representative primary focus is to conduct outbound calls to Molina members and schedule appointments with our Nurse Practitioners. As part of Molina's benefit package, the appointments are for preventive care services delivered in the home, community, and nursing facility settings.

Job Duties

• Conduct outbound calls to Molina members and schedule appointments with our Nurse Practitioners

• Understands and strives to meet or exceed call center metrics while providing high quality consistent customer service

• Removes barriers for member's, escalating high impact member issues

• Perform timely documentation in electronic medical record and provide daily audits and feedback

• Accurately schedule appointments to meet all key metrics based on individual scripts, Care Connections, state, and company goals,

• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

• Participate in special projects as assigned

• Other duties as assigned

JOB QUALIFICATIONS

Required Education

• High School Diploma or equivalency

Required Experience/Knowledge/Skills/Abilities

• Excellent customer service, active listening, verbal and written communication skills, professional phone voice.

• Working knowledge of Microsoft Office (Outlook, Word, Excel) or other comparable software

• Strong phone and verbal communication skills along with active listening

• Ability to multi-task, set priorities, high ability to pivot with change in strategy and manage time effectively.

• Problem solving skills.

• Attention to detail.

• Bilingual (English/Spanish, Chinese, Korean or Vietnamese)

Preferred Education

• Associate's degree or equivalent combination of education and experience

Preferred Experience

• Customer Service/Call Center experience in health care or equivalent related

• Experience doing outbound appointment setting or similar services

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

Pay Range: $12.19 - $26.42 / 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

Lead Systems Analyst, TCIM - Tech Support, Data Analytics, Emerging technologies

Job Description

The Technical Systems Analyst will be responsible for the design and development of moderate to complex SSIS solutions. Additionally, this role will require the development of automated operational reports and dashboards utilizing Power BI and SQL Server Reporting Services. The position requires three-five years' experience with tools and systems utilizing the Microsoft SQL BI Stack including SSIS, SSRS, TSQL, Power Query, MDX, PowerBI, and DAX. The role is also slated to help understand, design, research and work on emerging technologies.

Knowledge/Skills/Abilities

• Strong knowledge of SQL Server, SSIS and t-SQL, preferably on Azure and/or SQL 2016+ Proven ability to architect and develop solutions which perform data transformations using Microsoft SSIS/SQL ETL tools

• Design and develop SQL Server stored procedures, functions, views and triggers

• Design, implement and maintain SQL database objects (tables, views, indexes) and database security

• Debug and tune existing SSIS/ETL processes to ensure accurate and efficient movement of processed data

• Design, develop and maintain reports and dashboards in Power BI and SQL Server Reporting Services (SSRS).

• Ability to author reports having multiple data sources, complex queries, views, stored procedures, and automation features.

• Assist with database performance optimization and interoperability issues

• Collaborate with Product Owners to elicit and document business requirements for ETL and report design.

• Ability to translate business requirements into sound technical specifications

• Research issues and sets up proof of concept tests

• Support quality acceptance testing which includes the development and/or refinement of test plans

• Lead design review session with scrum team to validate requirements

• Troubleshoot data quality issues and defects to determine root cause

• Strong knowledge of writing BRD's.

• 5+ years software development experience with 3+ years SQL programming utilizing SSIS/SSRS and Power BI

• Experience working with Azure SQL Database, DevOps, GIT and Continual Integration (CI)

• Knowledge and/or experience of the Agile framework and working in a scrum team

• Basic to intermediate knowledge of C#

• Familiarity with healthcare data and concepts

• Familiarity with QNXT

• Excellent analytical and problem-solving abilities

• Strong written and oral communication skills

• Must be able to coach and mentor junior resources within the team.

Required Education

• Bachelor's Degree or equivalent combination of education and 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: $65,791.66 - $142,548.59 / 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

The Member Navigator primary function is to be the member's liaison. Primarily telephonic, this role is responsible for ensuring that the members member has assistance they may need in navigating their health care needs. Throughout the duration of services, the Member Navigator will communicate with members and caregivers to uncover and act on possible barriers to a healthy outcome, thereby safeguarding against unnecessary admissions, readmissions, urgent care, and emergency department visits.

KNOWLEDGE/SKILLS/ABILITIES

• Strong working knowledge of medical terminology and healthcare landscape preferred

• Excellent written and verbal communication skills to collaborate internally and externally with members, providers, team members, and manager

• Work in an independent manner with minimum supervision

• Excellent problem solving, critical thinking, and organizational skills

• Must be organized and able to prioritize, plan, and handle multiple tasks simultaneously

• Serve as the member's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures

• Make all member welcome calls on date of notification of assignment and/or discharge. Make appropriate and timely member appointments, confirmations, and appointment reminders. Mail letters as needed

• Complete telephonic visits with members utilizing current standard operating procedures

• Notify all appropriate departments of data related member case updates

• Outreach to members/members providers and input appointments

• Adhere to established guidelines for case closings

• Identify and connect member to resources for addressing Social Determinants of Health (SDOH) by utilizing resources from the Health Plan and Aunt Bertha

• Outreach to the appropriate party to report any benefit, authorization, claim or eligibility related issue

• Prepare information for member case status summaries, success stories, etc. and participate in daily huddles, weekly meetings, and other scheduled events, internally, and with members externally

• Prepare, communicate, and follow through on member issues that require escalation communications to management

• Conduct and collaborate on creating action plans for member barriers

• Review system related tasks and email instructions throughout the day for management of daily responsibilities to manage all assigned member cases effectively and thoroughly to completion

• Maintain member outreach and daily activities for cases assigned to out of office Member Navigators and peers as directed by leadership team

• Document accurately all phone calls, interventions, appointments and other system related data member concerns, questions, or complaints

• Consistently meet position Key Performance Indicator metrics as defined by leadership

• Other duties as assigned by leadership may exist to meet business needs.

• Bilingual (English/Spanish, Vietnamese, Chinese)

JOB QUALIFICATIONS

Required Education

High School Diploma or GED required

Required Experience

2+ years of customer service and/or healthcare experience in a fast-paced environment

Preferred Education

Associate Degree or higher from an accredited college preferred

Preferred Experience

• Computer proficiency to include typing, data entry, internet research, and spelling accuracy

• Proficient with Microsoft Office applications including Word, Excel and PowerPoint

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.

#PJCorp

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

Supporting the OH Plan, the candidate will act as a liaison to our state regulator on Encounters as well as lead various other technical programs under the OH Operations Department. These currently include support of provider data requirements, vendor data interfaces, Ohio Dept of Medicaid data interfaces, and be a technical resource that can liaison between OH Operations Dept and IT teams. Must be a self-starter willing to learn. Must be a good communicator, comfortable speaking up in group discussions and love work collaboratively with other teams and with senior leadership. This role involves research, root cause analysis, sharing recommendations, analyzing reports and other duties as specified.

Analyzes complex business problems and issues using member, provider, claims, and encounter data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Develops, implements and uses software and systems to identify issues in data sourced from state and federal agencies and loaded to internal systems.

• Identify data trends.

• Good knowledge of EDI X12 Transactions such as 834, 835, 837, etc.

• Uses comprehensive background to navigate analytical problems, including clearly defining and documenting their unique specifications.

• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

• Responsible for developing appropriate methodologies and preparation of weekly reports.

• Encourages cooperative interactions between cross functional teammates.

• Coordinates work of other business data analysts and provides training to subordinates/team members.

• Leverages expertise to review, research, analyze and evaluate all data relating to specific area of expertise.

• Actively leads in all stages of project development including research, design, programming, testing and implementation to ensures the released product meets the intended functional and operational requirements

• Uses mastery of subject matter to guide communication and collaboration with external and internal customers by analyzing their needs and goals.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

• 7+ years of business analysis experience,

• 6+ years managed care experience.

• Demonstrates expertise in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

• 6+ years experience working as a data or business analyst

• Experienced in developing ad-hoc and standard reports using SQL and Azure Databricks or similar tools to perform analysis on member enrollment data

• Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.

Preferred License, Certification, Association

QNXT or similar healthcare payer applications

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: $59,810.6 - $129,589.63 / 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'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 activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities.

Candidates with experience in a Quality/HEDIS/Clinical setting will receive first consideration. Please identify that experience on your resume.

KNOWLEDGE/SKILLS/ABILITIES

The Specialist, Quality Interventions/ QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.

• Implements key quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., removing barriers to care); preparation for Quality Improvement Compliance surveys; and other federal and state required quality activities.

• Monitors and ensures that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed.

• Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions.

• Creates, manages, and/or compiles the required documentation to maintain critical quality improvement functions.

• Leads quality improvement activities, meetings, and discussions with and between other departments within the organization.

• Evaluates project/program activities and results to identify opportunities for improvement.

• Surfaces to Manager and Director any gaps in processes that may require remediation.

• Other tasks, duties, projects, and programs as assigned.

This position may require same day out of office travel approximately 0 - 50% of the time, depending upon location.

This position may require multiple day out of town overnight travel approximately 0 - 20% of the time, depending upon location.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and work experience.

Required Experience

• Min. 3 years' experience in healthcare with 1 year experience in health plan quality improvement, managed care, or equivalent experience.

• Demonstrated solid business writing experience.

• Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Preferred Education

Preferred field: Clinical Quality, Public Health or Healthcare.

Preferred Experience

1 year of experience in Medicare and in Medicaid.

Preferred License, Certification, Association

• Certified Professional in Health Quality (CPHQ)

• Nursing License (RN may be preferred for specific roles)

• Certified HEDIS Compliance Auditor (CHCA)

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.

#PJQA

#LI-AC1

Pay Range: $19.64 - $42.55 / 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'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 activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities.

Candidates with experience in a Quality/HEDIS/Clinical setting will receive first consideration. Please identify that experience on your resume.

KNOWLEDGE/SKILLS/ABILITIES

The Specialist, Quality Interventions/ QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.

• Implements key quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., removing barriers to care); preparation for Quality Improvement Compliance surveys; and other federal and state required quality activities.

• Monitors and ensures that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed.

• Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions.

• Creates, manages, and/or compiles the required documentation to maintain critical quality improvement functions.

• Leads quality improvement activities, meetings, and discussions with and between other departments within the organization.

• Evaluates project/program activities and results to identify opportunities for improvement.

• Surfaces to Manager and Director any gaps in processes that may require remediation.

• Other tasks, duties, projects, and programs as assigned.

This position may require same day out of office travel approximately 0 - 50% of the time, depending upon location.

This position may require multiple day out of town overnight travel approximately 0 - 20% of the time, depending upon location.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and work experience.

Required Experience

• Min. 3 years' experience in healthcare with 1 year experience in health plan quality improvement, managed care, or equivalent experience.

• Demonstrated solid business writing experience.

• Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Preferred Education

Preferred field: Clinical Quality, Public Health or Healthcare.

Preferred Experience

1 year of experience in Medicare and in Medicaid.

Preferred License, Certification, Association

• Certified Professional in Health Quality (CPHQ)

• Nursing License (RN may be preferred for specific roles)

• Certified HEDIS Compliance Auditor (CHCA)

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.

#PJQA

#LI-AC1

Pay Range: $19.64 - $42.55 / 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'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 activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities.

Candidates with experience in a Quality/HEDIS/Clinical setting will receive first consideration. Please identify that experience on your resume.

KNOWLEDGE/SKILLS/ABILITIES

The Specialist, Quality Interventions/ QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.

• Implements key quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., removing barriers to care); preparation for Quality Improvement Compliance surveys; and other federal and state required quality activities.

• Monitors and ensures that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed.

• Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions.

• Creates, manages, and/or compiles the required documentation to maintain critical quality improvement functions.

• Leads quality improvement activities, meetings, and discussions with and between other departments within the organization.

• Evaluates project/program activities and results to identify opportunities for improvement.

• Surfaces to Manager and Director any gaps in processes that may require remediation.

• Other tasks, duties, projects, and programs as assigned.

This position may require same day out of office travel approximately 0 - 50% of the time, depending upon location.

This position may require multiple day out of town overnight travel approximately 0 - 20% of the time, depending upon location.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and work experience.

Required Experience

• Min. 3 years' experience in healthcare with 1 year experience in health plan quality improvement, managed care, or equivalent experience.

• Demonstrated solid business writing experience.

• Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Preferred Education

Preferred field: Clinical Quality, Public Health or Healthcare.

Preferred Experience

1 year of experience in Medicare and in Medicaid.

Preferred License, Certification, Association

• Certified Professional in Health Quality (CPHQ)

• Nursing License (RN may be preferred for specific roles)

• Certified HEDIS Compliance Auditor (CHCA)

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.

#PJQA

#LI-AC1

Pay Range: $19.64 - $42.55 / 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

Lead Systems Analyst, TCIM - Tech Support, Data Analytics, Emerging technologies

Job Description

The Technical Systems Analyst will be responsible for the design and development of moderate to complex SSIS solutions. Additionally, this role will require the development of automated operational reports and dashboards utilizing Power BI and SQL Server Reporting Services. The position requires three-five years' experience with tools and systems utilizing the Microsoft SQL BI Stack including SSIS, SSRS, TSQL, Power Query, MDX, PowerBI, and DAX. The role is also slated to help understand, design, research and work on emerging technologies.

Knowledge/Skills/Abilities

• Strong knowledge of SQL Server, SSIS and t-SQL, preferably on Azure and/or SQL 2016+ Proven ability to architect and develop solutions which perform data transformations using Microsoft SSIS/SQL ETL tools

• Design and develop SQL Server stored procedures, functions, views and triggers

• Design, implement and maintain SQL database objects (tables, views, indexes) and database security

• Debug and tune existing SSIS/ETL processes to ensure accurate and efficient movement of processed data

• Design, develop and maintain reports and dashboards in Power BI and SQL Server Reporting Services (SSRS).

• Ability to author reports having multiple data sources, complex queries, views, stored procedures, and automation features.

• Assist with database performance optimization and interoperability issues

• Collaborate with Product Owners to elicit and document business requirements for ETL and report design.

• Ability to translate business requirements into sound technical specifications

• Research issues and sets up proof of concept tests

• Support quality acceptance testing which includes the development and/or refinement of test plans

• Lead design review session with scrum team to validate requirements

• Troubleshoot data quality issues and defects to determine root cause

• Strong knowledge of writing BRD's.

• 5+ years software development experience with 3+ years SQL programming utilizing SSIS/SSRS and Power BI

• Experience working with Azure SQL Database, DevOps, GIT and Continual Integration (CI)

• Knowledge and/or experience of the Agile framework and working in a scrum team

• Basic to intermediate knowledge of C#

• Familiarity with healthcare data and concepts

• Familiarity with QNXT

• Excellent analytical and problem-solving abilities

• Strong written and oral communication skills

• Must be able to coach and mentor junior resources within the team.

Required Education

• Bachelor's Degree or equivalent combination of education and 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: $65,791.66 - $142,548.59 / ANNUAL

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

Job Detail

• Company:
  Molina Healthcare