Company Detail

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

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

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

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.

* New Grads are welcome*

You will love this job if:

• You consider yourself a self-starter and enjoy being outside of the four walls of a clinic or hospital.

• You consider yourself an innovator and would like to participate in pilots for new services or care models.

• You are tech savvy and want to learn more about Clinical Informatics or Health Information Technology.

• New grads/exp NP who want to make a difference in the community.

Who is the ideal candidate?

• A passion to serve the underserved

• Previous experience working with Medicaid, Marketplace, and Medicare populations.

• Epic EHR experience

• Bilingual or multi-lingual communication skills

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

Additional Perks

• Flexible scheduling with either 4x10-hour or 5x8-hour shift

• $30k nursing loan repayment over 3 years

• $2,500 + 40 hours for CME annually

• Home office stipend, mileage reimbursement, cell phone

• Tuition/Certification Reimbursement- $5,250 annually

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: $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

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

• Provides telephone, clerical, and data entry support for the Case Management team.

• Responsible for initial review of assigned case levels to assist in Case Management assignment.

• Reviews data to identify principal member needs and works under the direction of the Case Manager to implement care plan.

• Schedules member visits with team members as needed.

• Screens members using Molina policies and processes, assisting clinical Case Management staff as they identify appropriate medical services.

• Coordinates required services in accordance with member benefit plan.

• Promotes communication, both internally and externally to enhance effectiveness of case management services.

• Processes member and provider correspondence.

JOB QUALIFICATIONS

Required Education

• HS Diploma or GED

Required Experience

• 1-3 years' experience in an administrative support role in healthcare.

Preferred Education

• Associate degree

Preferred Experience

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

• Bilingual in Spanish

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

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.

Quality Improvement, HEDIS, Healthcare experience is very important for this position. Candidates with these skills will receive first consideration. Please identify this experience on your resume.

KNOWLEDGE/SKILLS/ABILITIES

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

• Acts as a lead specialist to provide project-, program-, and / or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments.

• 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.

JOB QUALIFICATIONS

Required Education

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

Required Experience

• Min. 3 years' experience in healthcare with minimum 2 years' 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.

• Experience with data reporting, analysis and/or interpretation.

Preferred License, Certification, Association

• Active, unrestricted Certified Professional in Health Quality (CPHQ)

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

• Active, unrestricted 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: $44,936.59 - $97,362.61 / 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 all aspects of taxation - compliance, planning, forecasting, M&A evaluation, expense, liability and asset recordation, SEC and statutory reporting disclosure, ASC740, FIN 48 and SFAS 123R reporting and disclosure, SOX 404 compliance, respond to tax agency inquiries and audits, research tax issues, financial audit response and coordination for tax matters.

This is a remote position, but there would be occasional required meetings at the Long Beach, CA office.

Knowledge/Skills/Abilities

• Assists with filing of federal, state and local consolidated/combined corporate income tax returns.

• Assists with preparation of quarterly and annual GAAP and statutory tax provisions including calculation of permanent and temporary differences and analysis of deferred tax assets and liabilities.

• Assists in reconciling tax payable accounts quarterly.

• Assists with quarterly federal and state corporate tax projections for estimated taxes and extensions, prepares related forms, and assists with payment requests and timely filings.

• Assists in preparing company-wide state apportionment schedules. Assists with calculation and documentation of tax credits.

Job Qualifications

Required Education

Bachelors Degree

Required Experience

0-1 Years

Preferred License, Certification, Association

CPA

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: $16.23 - $35.17 / 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

Job Summary

Responsible for the strategic development and administration of contracts with State and/or Federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide health care services to low income, uninsured, and other populations.

This is a remote position, but there will be occasional required meetings at the office in Columbia, SC.

KNOWLEDGE/SKILLS/ABILITIES

• Responsible for coordinating, conducting and/or responding to research requests pertaining to government healthcare programs; preparing and submitting regulatory reports for filings; reviewing Plan submissions for quality, accuracy, and timeliness; and ensuring Plan meets contractual and regulatory requirements.

• Reviews Provider Agreement, EOC/ Member Handbook, Provider Directory, marketing materials, and other contract reporting deliverables for compliance with contractual and regulatory requirements prior to submission.

• Assesses information received from government contracting agencies and regulators and disseminates to impacted Plan staff.

• Participates in meetings related to Molina government run programs with State agencies and Molina Corporate departments and disseminates relevant information to staff and management.

• Oversees/maintains the department's documentation and archive system, ensuring submitted reports are archived for historical and audit purposes. Ensures system is updated and complete.

JOB QUALIFICATIONS

Required Education

• High School diploma or equivalent

Required Experience

• 3 years' experience in a managed care environment.

• Experience demonstrating strong: communication and presentation skills; analytical/reasoning ability; detail orientation; organizational and interpersonal skills.

• Proficient in compiling data, creating reports, and presenting information, using Crystal Reports (or similar reporting tools), SQL query, MS Access, and MS Excel.

Preferred Education

• Bachelor's Degree in Business Administration, Healthcare, or related field.

Preferred Experience

• Experience working with a Medicaid program to include working with external regulators

• Experience working with and interpreting contracts

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

Opportunity for TX licensed RN residing in the southern part of Dallas County to join our LTSS Team as a Case Manager working with our Medicaid members. 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. Hours are Monday - Friday, 8 AM - 5 PM CST.

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

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 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

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

Must have experience in Value based payments and Provider Relations

Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

Job Duties

This role serves as the primary point of contact between Molina Health plan and the Plan's highest priority, high volume and strategic non-complex Provider Community that services Molina members, including but not limited to Fee-For-Service and Pay for Performance Providers. It is an external-facing, field-based position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage high priority providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.

- Under general supervision, works directly with the Plan's external providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. Effectiveness in driving timely issue resolution, EMR connectivity, Provider Portal Adoption.

- Resolves complex provider issues that may cross departmental lines and involve Senior Leadership.

- Serves as a subject matter expert for other departments.

- Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.

- Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship.

- Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters.

- Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. For example, such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding.

- Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's).

- Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include: administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.).

- Trains other Provider Relations Representatives as appropriate.

- Role requires 80%+ same-day or overnight travel. (Extent of overnight travel will depend on the specific Health Plan and its service area.)

Job Qualifications

REQUIRED EDUCATION :

Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

- 3 - 5 years customer service, provider service, or claims experience in a managed care setting.

- 3+ years experience in managed healthcare administration and/or Provider Services.

- Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to; fee-for service, capitation and various forms of risk, ASO, etc.

PREFERRED EXPERIENCE :

- 5+ years experience in managed healthcare administration and/or Provider Services.

- 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, groups and hospitals).

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: $62,400 - $97,362.61 / 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

Must have Claims Medical Exp

Analyzes complex business problems and issues using 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

• Provides analytical, problem solving foundation including: definition and documentation, specifications.

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

• Reviews, researches, analyzes and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.

• Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements.

• Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery and cost savings regulations are met

• Prepares high level user documentation and training materials as needed.

JOB QUALIFICATIONS

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

• 3-5 Years of business analysis

• 4+ years managed care experience

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

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

• 1-3 years formal training in Business Analysis and/or Systems Analysis

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: $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 Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

Job Duties

This role serves as the primary point of contact between Molina Health plan and the Plan's highest priority, high volume and strategic non-complex Provider Community that services Molina members, including but not limited to Fee-For-Service and Pay for Performance Providers. It is an external-facing, field-based position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage high priority providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.

- Under general supervision, works directly with the Plan's external providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. Effectiveness in driving timely issue resolution, EMR connectivity, Provider Portal Adoption.

- Resolves complex provider issues that may cross departmental lines and involve Senior Leadership.

- Serves as a subject matter expert for other departments.

- Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.

- Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship.

- Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters.

- Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. For example, such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding.

- Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's).

- Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include: administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.).

- Trains other Provider Relations Representatives as appropriate.

- Role requires 80%+ same-day or overnight travel. (Extent of overnight travel will depend on the specific Health Plan and its service area.)

Job Qualifications

REQUIRED EDUCATION :

Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

- 3 - 5 years customer service, provider service, or claims experience in a managed care setting.

- 3+ years experience in managed healthcare administration and/or Provider Services.

- Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to; fee-for service, capitation and various forms of risk, ASO, etc.

PREFERRED EXPERIENCE :

- 5+ years experience in managed healthcare administration and/or Provider Services.

- 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, groups and hospitals).

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: $62,400 - $97,362.61 / 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

Manages people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management, rather than the application of expertise in a specialized functional field of knowledge although they may have technical team members.

KNOWLEDGE/SKILLS/ABILITIES

• Outlines project goals, develops modes of assessment, manages project budgets, and ensures that all activity remains on schedule.

• Meets with company executives and business owners to determine time frame and goals for project.

• Outlines schedule and budget for project development.

• Oversees all expenses to ensure that activity remains within the project budget.

• Oversees daily activity of employees to ensure they are working efficiently.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

5-7 years

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

7-9 years

Preferred License, Certification, Association

PMP or Six Sigma Black Belt certification

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: $62,400 - $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

POPULATION / PUBLIC HEALTH REGISTERED NURSE CASE MANAGER

We are looking for a Case Manager who must reside and be able to drive within CLARK COUNTY NEVADA

Must have experience with chronic conditions and public health, communicable diseases, and engagement with community partners in the Clark County NV area.

Case Manager will work in remote and field setting our Medicaid Population. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Excellent skillset working with EMR's and Microsoft Office.

TRAVEL WILL BE REQUIRED (up to 40% 2 - 3 days a week ) in the field to do member visits in the surrounding areas. Travel will be within a 2 hour radius. A clean DMV driving record, proof of auto insurance, and reliable transportation is required.

Home office with internet connectivity of high speed required. You must provide your own home office including desk and chair.

Schedule: Monday thru Friday 8:00AM to 5:00PM.

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

• 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.

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

Must have Claims Medical Exp

Analyzes complex business problems and issues using 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

• Provides analytical, problem solving foundation including: definition and documentation, specifications.

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

• Reviews, researches, analyzes and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.

• Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements.

• Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery and cost savings regulations are met

• Prepares high level user documentation and training materials as needed.

JOB QUALIFICATIONS

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

• 3-5 Years of business analysis

• 4+ years managed care experience

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

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

• 1-3 years formal training in Business Analysis and/or Systems Analysis

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: $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

Manages people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management, rather than the application of expertise in a specialized functional field of knowledge although they may have technical team members.

KNOWLEDGE/SKILLS/ABILITIES

• Outlines project goals, develops modes of assessment, manages project budgets, and ensures that all activity remains on schedule.

• Meets with company executives and business owners to determine time frame and goals for project.

• Outlines schedule and budget for project development.

• Oversees all expenses to ensure that activity remains within the project budget.

• Oversees daily activity of employees to ensure they are working efficiently.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

5-7 years

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

7-9 years

Preferred License, Certification, Association

PMP or Six Sigma Black Belt certification

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: $62,400 - $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 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 Plan. We are seeking a RN candidate with previous knowledge of behavioral health and SUD conditions. The candidate should also have experience supporting social service needs, possess community resources, and health promotion experience. Further details will be discussed during the interview process.

Work schedule Monday- Friday 8:00 AM to 5:00 PM PST

Remote position with 60% field travel within Vancouver

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.

WA state RN license

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)

Behavioral Health 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: $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

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 Plan. We are seeking a RN candidate with previous knowledge of behavioral health and SUD conditions. The candidate should also have experience supporting social service needs, possess community resources, and health promotion experience. Further details will be discussed during the interview process.

Work schedule Monday- Friday 8:00 AM to 5:00 PM PST

Remote position with 60% field travel within Vancouver

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.

WA state RN license

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)

Behavioral Health 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: $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

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 program. We are seeking a Case Manager with one of the following licensures: BCBA (preferred) LCSW, LMHC, LSWAIC or LMFT. The candidate should have Case management experience, working with individuals with Autism/IDD, experience working within interdisciplinary teams, and experience with care planning. Further details to be discussed during our interview process.

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

Remote position with 25% field travel in Seattle, Vancouver, Bothell, Spokane, Bellingham

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.

BCBA (preferred) LCSW, LMHC, LSWAIC or LMFT Licensure

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.

Case management experience

Experience working with individuals with Autism/IDD

Experience working within interdisciplinary teams

Experience with care planning

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.

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

Are you seeking a unique nursing position that gives you a great work/life balance and lets you support people to live the lives that they choose? Then you'll want to keep reading about this rewarding work opportunity!

We are currently looking for a Registered Nurse licensed in Wisconsin to become our next IRIS Self-Directed Personal Care (SDPC) RN. This is a remote position, where you will partner with people in your community who are enrolled in the Wisconsin IRIS program - a Medicaid long-term care option for older adults and people with disabilities. People in the IRIS program who need personal care services have the choice to enroll in the IRIS Self-Directed Personal Care (IRIS SPDC) option. You can learn more about IRIS SDPC on the Wisconsin Department of Health Services website here (https://dhs.wisconsin.gov/iris/sdpc.htm) , and learn about the IRIS program here (https://dhs.wisconsin.gov/iris/index.htm) . While this role is home-based, you will have regularly scheduled visits with people in their homes and communities.

As an IRIS SDPC RN, you'll provide oversight and guidance to the people enrolled in the IRIS SDPC option. You'll also build relationships with the people you partner with and ensure that they're getting the most out of the IRIS Self-Directed Personal Care option through assessment, oversight, training and education.

IRIS SDPC RNs are responsible for administering the Wisconsin Personal Care Screening Tool; creating person-centered plans of care; providing personal care oversight to a group of people in IRIS, providing education and training for IRIS participants and care providers, and conducting the required documentation and follow-up. As an IRIS SDPC RN, you'll play an important role in helping people of various backgrounds and abilities live their lives the way they choose.

Knowledge/Skills/Abilities

• Provides personal care assessments and oversight to the My Cares Groups by administering the Wisconsin Personal Care Screening Tool and addendums as required

• Documents assessment as required by individual tool and Department of Health Services policies and by completing oversight visits and calls as required

• Oversees a My Cares Groups of participants, develops individual plans of care, ensures physician orders for care are obtained and reviews and revises plan of care as needed

• Submits for Prior Authorization for personal care services

• Complies with all Department of Health Services policies and SDPC Guidelines, procedures, and practices along with documentation and program regulations

• Provides personal care training to participants or care providers as requested and provides educational materials as needed

• Completes collateral contacts with IRIS Consultants and Long-Term Care Functional Screeners and physicians to ensure care needs are met

• Completes other duties as assigned

• Overtime work may be required

• May be required to drive 50% of the time during a given day of member home visits

• Exposure to members homes which may include navigating stairs, exposure to different environments, and pets

Job Qualifications

REQUIRED EDUCATION:

Associates Degree in Nursing

REQUIRED EXPERIENCE:

• Minimum 2 years of experience in nursing with at least one year of home health serving individuals with developmental disabilities, physical disabilities, or the elderly.

• Demonstrated computer and software skills required, proficiency with Microsoft Office Suite and database operation/maintenance skills and data entry experience.

• Excellent written and verbal communication skills required and the ability to adapt communication styles to fit situation.

• Strong teaching and mentoring skills.

• Strong analytical and problem-solving skills.

• Good organizational and time management skills with ability to manage tasks independently.

• Flexibility in the work environment and willingness and ability to adapt to changing organizational needs.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

Current unrestricted license in the state of Wisconsin as a Registered Nurse.

Valid Driver's License

PREFERRED EDUCATION:

Bachelor's Degree in Nursing

PREFERRED EXPERIENCE:

Experience providing care through the Wisconsin Medicaid Personal Care Program or one year of home care 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: $26.41 - $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 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.

* New Grads are welcome*

You will love this job if:

• You consider yourself a self-starter and enjoy being outside of the four walls of a clinic or hospital.

• You consider yourself an innovator and would like to participate in pilots for new services or care models.

• You are tech savvy and want to learn more about Clinical Informatics or Health Information Technology.

• New grads/exp NP who want to make a difference in the community.

Who is the ideal candidate?

• A passion to serve the underserved

• Previous experience working with Medicaid, Marketplace, and Medicare populations.

• Epic EHR experience

• Bilingual or multi-lingual communication skills

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

Additional Perks

• Flexible scheduling with either 4x10-hour or 5x8-hour shift

• $30k nursing loan repayment over 3 years

• $2,500 + 40 hours for CME annually

• Home office stipend, mileage reimbursement, cell phone

• Tuition/Certification Reimbursement- $5,250 annually

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