Company Detail

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

* Candidate must be able to work during EST hours*

Job Summary

Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.

KNOWLEDGE/SKILLS/ABILITIES

• Must have experience working with Provider reimbursement data.

• Working on Provider analytics in a healthcare or managed care environment is required.

• Experience working on SQL, Excel , Python or any other analytics tool is required.

• Develop ad-hoc reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, and other analytic / programming tools as needed.

• Generate and distribute standard reports on schedule using SQL, Excel, and other reporting software.

• Create new databases and reporting tools for monitoring, tracking and trending based on project specifications.

• Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and rework.

• Responsible for timely completion of projects, including timeline development and maintenance; coordinates activities and data collection with requesting internal departments or external requestors.

• Identify and complete report enhancements/fixes; modify reports in response to approved change requests; retain old and new report design for audit trail purposes.

• Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors.

• Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.

• Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.

• Maintains SharePoint Sites as needed.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Finance, Economics, Computer Science

Required Experience

• 5-7 years increasingly complex database and data management responsibilities

• 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics

• Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare

• Basic knowledge of SQL

• Preferred Education

• Bachelor's Degree in Finance, Economics, Math, or Computer Science

Preferred Experience

Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:

• Proactively identify and investigate complex suspect areas regarding medical cost issues

• Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan

• 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.

• Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions

• Healthcare Analyst I or Financial/Accounting Analyst I experience desired

• Multiple data systems and models

• BI tools

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

Provides application technical support and design on clinical information systems. Applies system knowledge to create workflows, change management processes, and ensure enhancements and defects are resolved effectively.

KNOWLEDGE/SKILLS/ABILITIES

• Serves as a technical leader for all applications, including the development and support of clinical, practice management and operational workflows.

• Provides strategic approach for workflow analysis, device integration, planning and implementation as it relates to clinical systems.

• Responsible for participating in the planning, development, implementation, testing, training, and maintenance of the electronic medical record application.

• Assists in problem/issue resolution and executes formal Change Management process for the business.

JOB QUALIFICATIONS

Required Education

HS Diploma or GED

Required Experience

4+ years of system implementation experience

Preferred Education

Bachelor's degree in Healthcare, Business,

Information Technology or related field preferred

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

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

Pay Range: $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

* Candidate must be able to work during EST hours*

Job Summary

Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.

KNOWLEDGE/SKILLS/ABILITIES

• Must have experience working with Provider reimbursement data.

• Working on Provider analytics in a healthcare or managed care environment is required.

• Experience working on SQL, Excel , Python or any other analytics tool is required.

• Develop ad-hoc reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, and other analytic / programming tools as needed.

• Generate and distribute standard reports on schedule using SQL, Excel, and other reporting software.

• Create new databases and reporting tools for monitoring, tracking and trending based on project specifications.

• Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and rework.

• Responsible for timely completion of projects, including timeline development and maintenance; coordinates activities and data collection with requesting internal departments or external requestors.

• Identify and complete report enhancements/fixes; modify reports in response to approved change requests; retain old and new report design for audit trail purposes.

• Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors.

• Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.

• Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.

• Maintains SharePoint Sites as needed.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Finance, Economics, Computer Science

Required Experience

• 5-7 years increasingly complex database and data management responsibilities

• 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics

• Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare

• Basic knowledge of SQL

• Preferred Education

• Bachelor's Degree in Finance, Economics, Math, or Computer Science

Preferred Experience

Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:

• Proactively identify and investigate complex suspect areas regarding medical cost issues

• Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan

• 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.

• Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions

• Healthcare Analyst I or Financial/Accounting Analyst I experience desired

• Multiple data systems and models

• BI tools

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

Provides application technical support and design on clinical information systems. Applies system knowledge to create workflows, change management processes, and ensure enhancements and defects are resolved effectively.

KNOWLEDGE/SKILLS/ABILITIES

• Serves as a technical leader for all applications, including the development and support of clinical, practice management and operational workflows.

• Provides strategic approach for workflow analysis, device integration, planning and implementation as it relates to clinical systems.

• Responsible for participating in the planning, development, implementation, testing, training, and maintenance of the electronic medical record application.

• Assists in problem/issue resolution and executes formal Change Management process for the business.

JOB QUALIFICATIONS

Required Education

HS Diploma or GED

Required Experience

4+ years of system implementation experience

Preferred Education

Bachelor's degree in Healthcare, Business,

Information Technology or related field preferred

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

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

Pay Range: $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

The Manager, Business Development, Facilitated Enrollments, is responsible for for overseeing daily operations and driving individual and team performance. The Manager will lead a team of Facilitated Enrollers in a designated region(s) making data-informed decisions to drive performance, resource allocation and lead generation.

This is a field-based leadership role that is accountable for meeting sales and enrollment targets, as well as increasing market share, leveraging product and market synergies driving overall membership growth and retention. Leads managed-care related business development activities for competitive intelligence, which may also include attendance/participation national, state, and local conferences, seminars, and meetings as well as any other business development support activities, as needed.

Job Duties

• Manage and oversee a local field-based team of Facilitated Enrollers that orchestrate member events, potential customer events, and community-based goodwill and general awareness that make Molina the insurer of choice

• Leads business development support projects from inception through completion.

• Develop and execute effective business plans to reflect strategy, tactics, key relationships, and commensurate resources for the respective region. This will include goals, recruitment, sales/business development events, market partnerships, and engagement

• Conduct regular sales-related training/coaching, focusing on increasing sales, overcoming objections, expanding markets, selling the full portfolio, presentations skills, prospecting, compliance and quality updates, etc.

• Build, maintain, deepen, and leverage internal and external strategic relationships that create sales opportunities.

• Leads analyses and market research utilized for business development activities.

• Gathers research and intelligence, including monitoring activity in other markets.

• Create and execute effective resource sharing strategies, including lead routing, kiosk assignments, community meeting assignments, and participation in other Molina best practices.

• Collaborate with the Marketing team to produce positive outcomes, notably lead generation, member enrollment, and membership growth

• Focus on professional development of the team and mentoring the Facilitated Enrollers

• Develop and implement provider engagement strategies

• Ensure compliance with state regulations as well as health plan policies and procedures

Job Qualifications

REQUIRED EDUCATION :

Bachelor's Degree or equivalent work experience

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

• Minimum 5-7 years sales or sales experience (Demonstrated experience managing a team of sales and/or outreach staff with KPIs in a regulated environment)

• Minimum 5-7 years of business to business, business to consumer direct marketing, outside sales, or community outreach experience

• Demonstrated Proficiency in Microsoft Office; Agility in the use of data management databases (i.e. SharePoint, PowerBi).

• Strong communication skills, including written, phone and video to manage and engage with corporate and external partners (ie Providers, community based organizations, etc...) in a culturally competent manner

• Strong relationship building skills and ability to work engage customers and prospective members

• Ability to manage and prioritize deliverables

• Effective in sourcing and use of market research information and market strategies

• Prior experience in structured sales, service, or business development

• Experience in a deadline-driven environment to meet or exceed sales promotion/marketing targets in compliant manner within a heavily regulated marketplace.

• Understanding of Individual Exchange, Medicaid, and NY State of Health Marketplace

• Able to travel State wide up to 80% of the time within assigned sales territories

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION :

• Must have reliable transportation and a valid state driver's license with no restrictions meeting Molina requirements

PREFERRED EDUCATION :

• Graduate Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE :

• Understanding of the healthcare industry

• Bilingual skills

• Local market experience

• Experience working with communities of all different ethnicities, cultural backgrounds, diverse populations, and/or underserved communities

• Creative thinker with proven track record of innovative ideas working within structured (including matrixed organizations), high velocity environments

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

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

Pay Range: $72,370.82 - $156,803.45 / ANNUAL

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

* Candidate must be able to work during EST hours*

Job Summary

Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.

KNOWLEDGE/SKILLS/ABILITIES

• Must have experience working with Provider reimbursement data.

• Working on Provider analytics in a healthcare or managed care environment is required.

• Experience working on SQL, Excel , Python or any other analytics tool is required.

• Develop ad-hoc reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, and other analytic / programming tools as needed.

• Generate and distribute standard reports on schedule using SQL, Excel, and other reporting software.

• Create new databases and reporting tools for monitoring, tracking and trending based on project specifications.

• Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and rework.

• Responsible for timely completion of projects, including timeline development and maintenance; coordinates activities and data collection with requesting internal departments or external requestors.

• Identify and complete report enhancements/fixes; modify reports in response to approved change requests; retain old and new report design for audit trail purposes.

• Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors.

• Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.

• Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.

• Maintains SharePoint Sites as needed.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Finance, Economics, Computer Science

Required Experience

• 5-7 years increasingly complex database and data management responsibilities

• 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics

• Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare

• Basic knowledge of SQL

• Preferred Education

• Bachelor's Degree in Finance, Economics, Math, or Computer Science

Preferred Experience

Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:

• Proactively identify and investigate complex suspect areas regarding medical cost issues

• Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan

• 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.

• Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions

• Healthcare Analyst I or Financial/Accounting Analyst I experience desired

• Multiple data systems and models

• BI tools

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

Provides application technical support and design on clinical information systems. Applies system knowledge to create workflows, change management processes, and ensure enhancements and defects are resolved effectively.

KNOWLEDGE/SKILLS/ABILITIES

• Serves as a technical leader for all applications, including the development and support of clinical, practice management and operational workflows.

• Provides strategic approach for workflow analysis, device integration, planning and implementation as it relates to clinical systems.

• Responsible for participating in the planning, development, implementation, testing, training, and maintenance of the electronic medical record application.

• Assists in problem/issue resolution and executes formal Change Management process for the business.

JOB QUALIFICATIONS

Required Education

HS Diploma or GED

Required Experience

4+ years of system implementation experience

Preferred Education

Bachelor's degree in Healthcare, Business,

Information Technology or related field preferred

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

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

Pay Range: $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

* Candidate must be able to work during EST hours*

Job Summary

Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.

KNOWLEDGE/SKILLS/ABILITIES

• Must have experience working with Provider reimbursement data.

• Working on Provider analytics in a healthcare or managed care environment is required.

• Experience working on SQL, Excel , Python or any other analytics tool is required.

• Develop ad-hoc reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, and other analytic / programming tools as needed.

• Generate and distribute standard reports on schedule using SQL, Excel, and other reporting software.

• Create new databases and reporting tools for monitoring, tracking and trending based on project specifications.

• Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and rework.

• Responsible for timely completion of projects, including timeline development and maintenance; coordinates activities and data collection with requesting internal departments or external requestors.

• Identify and complete report enhancements/fixes; modify reports in response to approved change requests; retain old and new report design for audit trail purposes.

• Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors.

• Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.

• Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.

• Maintains SharePoint Sites as needed.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Finance, Economics, Computer Science

Required Experience

• 5-7 years increasingly complex database and data management responsibilities

• 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics

• Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare

• Basic knowledge of SQL

• Preferred Education

• Bachelor's Degree in Finance, Economics, Math, or Computer Science

Preferred Experience

Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:

• Proactively identify and investigate complex suspect areas regarding medical cost issues

• Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan

• 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.

• Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions

• Healthcare Analyst I or Financial/Accounting Analyst I experience desired

• Multiple data systems and models

• BI tools

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

We are seeking a CASE MANAGER for our NEW MEXICO Health Plan. Candidates must live in VALENCIA COUNTY OR BERNALILLO COUNTY in the state of New Mexico for consideration.

Case Managers will work in remote and field settings 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 is required to do member visits in the surrounding areas. A clean DMV driving record, proof of auto insurance, and reliable transportation is required. Must be able to do your own driving. Please consider this requirement before you apply to this role.

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

Schedule: Monday thru Friday 8/8:30AM to 5/5:30PM Pacific.

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

• Facilitates interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration.

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

• Assesses for barriers to care, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

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

• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background

REQUIRED EXPERIENCE:

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

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

PREFERRED EXPERIENCE:

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

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

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

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

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

The Marketplace Facilitated Enroller (MFE) is responsible for identifying prospective members that do not have health insurance and assisting with the enrollment process ultimately making it easier for them to connect to the care they need. The MFE conducts interviews and screens potentially eligible recipients for enrollment into Government Programs such as Medicaid/Medicaid Managed Care, Child Health Plus and Essential Plan. Additionally, the MFE will assist in enrollment into Qualified Health Plans. The MFE must offer all plans and all products. MFEs assist families with their applications, provides assistance with completing the application, gathers the necessary documentation, and assists in selection of the appropriate health plan. The Enroller provides information on managed care programs and how to access care. The MFE is responsible for processing paperwork completely and accurately, including follow up visit documentation and other necessary reports. The MFE is also responsible for assisting current members with recertification with their plan. MFEs must source, develop and maintain professional, congenial relationships with local community agencies as well as county and state agency personnel who refer potentially eligible recipients.

KNOWLEDGE/SKILLS/ABILITIES

• Responsible for achieving monthly, quarterly, and annual enrollment goals and growth targets, as established by management.

• Interview, screen and assist potentially eligible recipients with the enrollment process into Medicaid/Medicaid Managed Care, Child Health Plus the Essential Plan and Qualified Health Plans for Molina and other plans who operate in our service area

• Meet with consumers at various sites throughout the communities

• Provide education and support to individuals who are navigating a complex system by assisting consumers with the application process, explaining requirements and necessary documentation

• Identify and educate potential members on all aspects of the plan including answering questions regarding plan's features and benefits and walking client through the required disclosures

• Educate members on their options to make premium payments, including due dates

• Assist clients with choosing a plan and primary care physician

• Submit all completed applications, adhering to submission deadline dates as imposed by NYSOH and Molina enrollment guidelines and requirements

• Responsible for identifying and assisting current members who are due to re-certify their healthcare coverage by completing the annual recertification application including adding on additional eligible family members

• Respond to inquiries from prospective members and members within the marketing guidelines

• Must adhere to all NYSOH rules and regulations as applicable for MFE functions

• Outreach Projects

• Participate in events and community outreach projects to other agencies as assigned by Management for a minimum of 8 hours per week

• Establish and maintain good working relationships with external business partners such as hospital and provider

• organizations, city agencies and community-based organizations where enrollment activities are conducted

• Develop and strengthen relations to generate new opportunities

• Attend external meetings as required

• Attend community health fairs and events as required

• Occasional weekend or evening availability for special events.

JOB QUALIFICATIONS

Required Education

HS Diploma

Required Experience

• Minimum one year of experience working with State and Federal Health Insurance programs and populations

• Demonstrated organizational skills, time management skills and ability to work independently

• Ability to meet deadlines

• Excellent written and oral communication skills; strong presentation skills

• Basic computer skills including Microsoft Word and Excel

• Strong interpersonal skills

• A positive attitude with ability to adapt to change

• Must have reliable transportation and a valid NYS drivers' license with no restrictions

• Knowledge of Managed Care insurance plans

• Ability to work with a diverse population, including different ethnicities, cultural backgrounds, and/or underserved communities

• Ability to work a flexible schedule, including nights and weekends

Required License, Certification, Association

Successful completion of the NYSOH required training, certification and recertification

Preferred Education

AA/AS - Associates degree

Preferred Experience

Previous experience as a Marketplace Facilitated Enroller - Bilingual - Spanish & English

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 - $31.97 / 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

* Candidate must be able to work during EST hours*

Job Summary

Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.

KNOWLEDGE/SKILLS/ABILITIES

• Must have experience working with Provider reimbursement data.

• Working on Provider analytics in a healthcare or managed care environment is required.

• Experience working on SQL, Excel , Python or any other analytics tool is required.

• Develop ad-hoc reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, and other analytic / programming tools as needed.

• Generate and distribute standard reports on schedule using SQL, Excel, and other reporting software.

• Create new databases and reporting tools for monitoring, tracking and trending based on project specifications.

• Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and rework.

• Responsible for timely completion of projects, including timeline development and maintenance; coordinates activities and data collection with requesting internal departments or external requestors.

• Identify and complete report enhancements/fixes; modify reports in response to approved change requests; retain old and new report design for audit trail purposes.

• Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors.

• Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.

• Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.

• Maintains SharePoint Sites as needed.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Finance, Economics, Computer Science

Required Experience

• 5-7 years increasingly complex database and data management responsibilities

• 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics

• Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare

• Basic knowledge of SQL

• Preferred Education

• Bachelor's Degree in Finance, Economics, Math, or Computer Science

Preferred Experience

Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:

• Proactively identify and investigate complex suspect areas regarding medical cost issues

• Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan

• 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.

• Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions

• Healthcare Analyst I or Financial/Accounting Analyst I experience desired

• Multiple data systems and models

• BI tools

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

Provides application technical support and design on clinical information systems. Applies system knowledge to create workflows, change management processes, and ensure enhancements and defects are resolved effectively.

KNOWLEDGE/SKILLS/ABILITIES

• Serves as a technical leader for all applications, including the development and support of clinical, practice management and operational workflows.

• Provides strategic approach for workflow analysis, device integration, planning and implementation as it relates to clinical systems.

• Responsible for participating in the planning, development, implementation, testing, training, and maintenance of the electronic medical record application.

• Assists in problem/issue resolution and executes formal Change Management process for the business.

JOB QUALIFICATIONS

Required Education

HS Diploma or GED

Required Experience

4+ years of system implementation experience

Preferred Education

Bachelor's degree in Healthcare, Business,

Information Technology or related field preferred

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

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

Pay Range: $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

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 Transition of Care program. We are seeking a candidate with one of the following licensures: LPN, LSWAIC, LICSW, LMHC, or LMHCA. Excellent computer skills and attention to detail are very important. The ToC Coach will multitask between systems, talk with members/providers on the phone, enter accurate and timely contact notes. Previous experience with discharge planning, collaborating with Providers, transportation and additional resources. Must be able to work independently with a quick turn over to ensure our members receive the adequate resources for discharge. Experience with the adult behavioral health system in Washington State is highly preferred . Further details to be discussed during our interview process.

Remote position with field travel in Seattle, Tacoma or Everette WA

Work schedule M-F 8:30 AM to 5:00 PM PST.

KNOWLEDGE/SKILLS/ABILITIES

• Manage and process HCS requests for Supportive Supervision and Behavioral Health Personal Care benefits within required timelines.

• Create and update authorizations

• Utilize advanced clinical skills to review Care Assessments and available collateral information against criteria to support decision making.

• Comply with all policies, procedures, and documentation standards in appropriate systems, tracking mechanisms and databases.

• Collaborate with providers to determine acuity of mental health concerns, barriers, and progress; coordinate appropriate services.

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

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

JOB QUALIFICATIONS

Required Education

Any of the following:

• Completion of an accredited Licensed Vocational Nurse (LVN)

• Licensed Practical Nurse (LPN) Program

• Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work.

Required Experience

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

• Knowledge of or experience using the Care Transitions Intervention or similar model; background in discharge planning and/or home health.

Required License, Certification, Association

• If required by applicable State, an LVN/LPN license in good standing.

• Otherwise, If licensed, 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.

Preferred Experience

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

Preferred License, Certification, Association

Any of the following:

• Transitions of Care Sub-Specialty Certification

• 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

• 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

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 Transition of Care program. We are seeking a candidate with one of the following licensures: LPN, LSWAIC, LICSW, LMHC, or LMHCA. Excellent computer skills and attention to detail are very important. The ToC Coach will multitask between systems, talk with members/providers on the phone, enter accurate and timely contact notes. Previous experience with discharge planning, collaborating with Providers, transportation and additional resources. Must be able to work independently with a quick turn over to ensure our members receive the adequate resources for discharge. Experience with the adult behavioral health system in Washington State is highly preferred . Further details to be discussed during our interview process.

Remote position with field travel in Seattle, Tacoma or Everette WA

Work schedule M-F 8:30 AM to 5:00 PM PST.

KNOWLEDGE/SKILLS/ABILITIES

• Manage and process HCS requests for Supportive Supervision and Behavioral Health Personal Care benefits within required timelines.

• Create and update authorizations

• Utilize advanced clinical skills to review Care Assessments and available collateral information against criteria to support decision making.

• Comply with all policies, procedures, and documentation standards in appropriate systems, tracking mechanisms and databases.

• Collaborate with providers to determine acuity of mental health concerns, barriers, and progress; coordinate appropriate services.

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

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

JOB QUALIFICATIONS

Required Education

Any of the following:

• Completion of an accredited Licensed Vocational Nurse (LVN)

• Licensed Practical Nurse (LPN) Program

• Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work.

Required Experience

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

• Knowledge of or experience using the Care Transitions Intervention or similar model; background in discharge planning and/or home health.

Required License, Certification, Association

• If required by applicable State, an LVN/LPN license in good standing.

• Otherwise, If licensed, 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.

Preferred Experience

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

Preferred License, Certification, Association

Any of the following:

• Transitions of Care Sub-Specialty Certification

• 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

• 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

Provides application technical support and design on clinical information systems. Applies system knowledge to create workflows, change management processes, and ensure enhancements and defects are resolved effectively.

KNOWLEDGE/SKILLS/ABILITIES

• Serves as a technical leader for all applications, including the development and support of clinical, practice management and operational workflows.

• Provides strategic approach for workflow analysis, device integration, planning and implementation as it relates to clinical systems.

• Responsible for participating in the planning, development, implementation, testing, training, and maintenance of the electronic medical record application.

• Assists in problem/issue resolution and executes formal Change Management process for the business.

JOB QUALIFICATIONS

Required Education

HS Diploma or GED

Required Experience

4+ years of system implementation experience

Preferred Education

Bachelor's degree in Healthcare, Business,

Information Technology or related field preferred

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

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

Pay Range: $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

* Candidate must be able to work during EST hours*

Job Summary

Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.

KNOWLEDGE/SKILLS/ABILITIES

• Must have experience working with Provider reimbursement data.

• Working on Provider analytics in a healthcare or managed care environment is required.

• Experience working on SQL, Excel , Python or any other analytics tool is required.

• Develop ad-hoc reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, and other analytic / programming tools as needed.

• Generate and distribute standard reports on schedule using SQL, Excel, and other reporting software.

• Create new databases and reporting tools for monitoring, tracking and trending based on project specifications.

• Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and rework.

• Responsible for timely completion of projects, including timeline development and maintenance; coordinates activities and data collection with requesting internal departments or external requestors.

• Identify and complete report enhancements/fixes; modify reports in response to approved change requests; retain old and new report design for audit trail purposes.

• Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors.

• Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.

• Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.

• Maintains SharePoint Sites as needed.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Finance, Economics, Computer Science

Required Experience

• 5-7 years increasingly complex database and data management responsibilities

• 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics

• Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare

• Basic knowledge of SQL

• Preferred Education

• Bachelor's Degree in Finance, Economics, Math, or Computer Science

Preferred Experience

Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:

• Proactively identify and investigate complex suspect areas regarding medical cost issues

• Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan

• 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.

• Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions

• Healthcare Analyst I or Financial/Accounting Analyst I experience desired

• Multiple data systems and models

• BI tools

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

Provides application technical support and design on clinical information systems. Applies system knowledge to create workflows, change management processes, and ensure enhancements and defects are resolved effectively.

KNOWLEDGE/SKILLS/ABILITIES

• Serves as a technical leader for all applications, including the development and support of clinical, practice management and operational workflows.

• Provides strategic approach for workflow analysis, device integration, planning and implementation as it relates to clinical systems.

• Responsible for participating in the planning, development, implementation, testing, training, and maintenance of the electronic medical record application.

• Assists in problem/issue resolution and executes formal Change Management process for the business.

JOB QUALIFICATIONS

Required Education

HS Diploma or GED

Required Experience

4+ years of system implementation experience

Preferred Education

Bachelor's degree in Healthcare, Business,

Information Technology or related field preferred

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

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

Pay Range: $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

* Candidate must be able to work during EST hours*

Job Summary

Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.

KNOWLEDGE/SKILLS/ABILITIES

• Must have experience working with Provider reimbursement data.

• Working on Provider analytics in a healthcare or managed care environment is required.

• Experience working on SQL, Excel , Python or any other analytics tool is required.

• Develop ad-hoc reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, and other analytic / programming tools as needed.

• Generate and distribute standard reports on schedule using SQL, Excel, and other reporting software.

• Create new databases and reporting tools for monitoring, tracking and trending based on project specifications.

• Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and rework.

• Responsible for timely completion of projects, including timeline development and maintenance; coordinates activities and data collection with requesting internal departments or external requestors.

• Identify and complete report enhancements/fixes; modify reports in response to approved change requests; retain old and new report design for audit trail purposes.

• Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors.

• Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.

• Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.

• Maintains SharePoint Sites as needed.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Finance, Economics, Computer Science

Required Experience

• 5-7 years increasingly complex database and data management responsibilities

• 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics

• Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare

• Basic knowledge of SQL

• Preferred Education

• Bachelor's Degree in Finance, Economics, Math, or Computer Science

Preferred Experience

Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:

• Proactively identify and investigate complex suspect areas regarding medical cost issues

• Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan

• 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.

• Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions

• Healthcare Analyst I or Financial/Accounting Analyst I experience desired

• Multiple data systems and models

• BI tools

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

We are seeking a CASE MANAGER for our NEW MEXICO Health Plan. Candidates must live in VALENCIA COUNTY OR BERNALILLO COUNTY in the state of New Mexico for consideration.

Case Managers will work in remote and field settings 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 is required to do member visits in the surrounding areas. A clean DMV driving record, proof of auto insurance, and reliable transportation is required. Must be able to do your own driving. Please consider this requirement before you apply to this role.

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

Schedule: Monday thru Friday 8/8:30AM to 5/5:30PM Pacific.

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

• Facilitates interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration.

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

• Assesses for barriers to care, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

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

• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background

REQUIRED EXPERIENCE:

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

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

PREFERRED EXPERIENCE:

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

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

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

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

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

* Candidate must be able to work during EST hours*

Job Summary

Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.

KNOWLEDGE/SKILLS/ABILITIES

• Must have experience working with Provider reimbursement data.

• Working on Provider analytics in a healthcare or managed care environment is required.

• Experience working on SQL, Excel , Python or any other analytics tool is required.

• Develop ad-hoc reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, and other analytic / programming tools as needed.

• Generate and distribute standard reports on schedule using SQL, Excel, and other reporting software.

• Create new databases and reporting tools for monitoring, tracking and trending based on project specifications.

• Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and rework.

• Responsible for timely completion of projects, including timeline development and maintenance; coordinates activities and data collection with requesting internal departments or external requestors.

• Identify and complete report enhancements/fixes; modify reports in response to approved change requests; retain old and new report design for audit trail purposes.

• Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors.

• Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.

• Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.

• Maintains SharePoint Sites as needed.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Finance, Economics, Computer Science

Required Experience

• 5-7 years increasingly complex database and data management responsibilities

• 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics

• Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare

• Basic knowledge of SQL

• Preferred Education

• Bachelor's Degree in Finance, Economics, Math, or Computer Science

Preferred Experience

Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:

• Proactively identify and investigate complex suspect areas regarding medical cost issues

• Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan

• 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.

• Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions

• Healthcare Analyst I or Financial/Accounting Analyst I experience desired

• Multiple data systems and models

• BI tools

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

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

Pay Range: $59,810.6 - $129,589.63 / ANNUAL

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Molina 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 Transition of Care program. We are seeking a candidate with one of the following licensures: LPN, LSWAIC, LICSW, LMHC, or LMHCA. Excellent computer skills and attention to detail are very important. The ToC Coach will multitask between systems, talk with members/providers on the phone, enter accurate and timely contact notes. Previous experience with discharge planning, collaborating with Providers, transportation and additional resources. Must be able to work independently with a quick turn over to ensure our members receive the adequate resources for discharge. Experience with the adult behavioral health system in Washington State is highly preferred . Further details to be discussed during our interview process.

Remote position with field travel in Seattle, Tacoma or Everette WA

Work schedule M-F 8:30 AM to 5:00 PM PST.

KNOWLEDGE/SKILLS/ABILITIES

• Manage and process HCS requests for Supportive Supervision and Behavioral Health Personal Care benefits within required timelines.

• Create and update authorizations

• Utilize advanced clinical skills to review Care Assessments and available collateral information against criteria to support decision making.

• Comply with all policies, procedures, and documentation standards in appropriate systems, tracking mechanisms and databases.

• Collaborate with providers to determine acuity of mental health concerns, barriers, and progress; coordinate appropriate services.

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

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

JOB QUALIFICATIONS

Required Education

Any of the following:

• Completion of an accredited Licensed Vocational Nurse (LVN)

• Licensed Practical Nurse (LPN) Program

• Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work.

Required Experience

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

• Knowledge of or experience using the Care Transitions Intervention or similar model; background in discharge planning and/or home health.

Required License, Certification, Association

• If required by applicable State, an LVN/LPN license in good standing.

• Otherwise, If licensed, 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.

Preferred Experience

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

Preferred License, Certification, Association

Any of the following:

• Transitions of Care Sub-Specialty Certification

• 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

• 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

* Candidate must be able to work during EST hours*

Job Summary

Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.

KNOWLEDGE/SKILLS/ABILITIES

• Must have experience working with Provider reimbursement data.

• Working on Provider analytics in a healthcare or managed care environment is required.

• Experience working on SQL, Excel , Python or any other analytics tool is required.

• Develop ad-hoc reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, and other analytic / programming tools as needed.

• Generate and distribute standard reports on schedule using SQL, Excel, and other reporting software.

• Create new databases and reporting tools for monitoring, tracking and trending based on project specifications.

• Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and rework.

• Responsible for timely completion of projects, including timeline development and maintenance; coordinates activities and data collection with requesting internal departments or external requestors.

• Identify and complete report enhancements/fixes; modify reports in response to approved change requests; retain old and new report design for audit trail purposes.

• Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors.

• Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.

• Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.

• Maintains SharePoint Sites as needed.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Finance, Economics, Computer Science

Required Experience

• 5-7 years increasingly complex database and data management responsibilities

• 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics

• Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare

• Basic knowledge of SQL

• Preferred Education

• Bachelor's Degree in Finance, Economics, Math, or Computer Science

Preferred Experience

Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:

• Proactively identify and investigate complex suspect areas regarding medical cost issues

• Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan

• 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.

• Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions

• Healthcare Analyst I or Financial/Accounting Analyst I experience desired

• Multiple data systems and models

• BI tools

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

Provides application technical support and design on clinical information systems. Applies system knowledge to create workflows, change management processes, and ensure enhancements and defects are resolved effectively.

KNOWLEDGE/SKILLS/ABILITIES

• Serves as a technical leader for all applications, including the development and support of clinical, practice management and operational workflows.

• Provides strategic approach for workflow analysis, device integration, planning and implementation as it relates to clinical systems.

• Responsible for participating in the planning, development, implementation, testing, training, and maintenance of the electronic medical record application.

• Assists in problem/issue resolution and executes formal Change Management process for the business.

JOB QUALIFICATIONS

Required Education

HS Diploma or GED

Required Experience

4+ years of system implementation experience

Preferred Education

Bachelor's degree in Healthcare, Business,

Information Technology or related field preferred

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

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

Pay Range: $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

Case Manager will work in remote and field setting supporting our Medicaid SMI (Severe Mental Illness) Population in the state of South Carolina. Case Manager will be required to communicate telephonically and complete Face to Face meetings. You will participate in interdisciplinary care team meetings for our members and ensure they have care plans based on their concerns/health needs. 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.

TRAVEL (30% or less) in the field to do member visits in the surrounding areas will be required.

Home office with internet connectivity of high speed required.

Schedule: Monday thru Friday 8:00AM to 5:00PM EST. - No weekends or Holiday

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

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

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

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

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

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

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Any of the following:

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

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

STATE SPECIFIC REQUIREMENTS:

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

PREFERRED EXPERIENCE:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Any of the following:

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

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

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

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