Company Detail

Job Description

Job Description

Job Summary

Serves as claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are appropriately applied. Manages and leads major claims projects of considerable complexity and volume that may be initiated through provider inquiries or complaints, legal requests, or identified internally by Molina. Identifies the root cause of processing errors through research and analysis, coordinates and engages with appropriate departments, develops and tracks remediation plans, and monitors claims reprocessing through resolution. Interprets and presents in-depth analysis of findings and results to leadership and respective operations teams. Responsible for ensuring the projects are completed accurately and timely.

Job Duties

• Uses analytical skills to conducts research and analysis for issues, requests, and inquiries of high priority claims projects

• Assists with reducing re-work by identifying and remediating claims processing issues

• Locate and interpret regulatory and contractual requirements

• Tailors existing reports or available data to meet the needs of the claims project

• Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing errors

• Applies claims processing and technical knowledge to appropriately define a path for short/long term systematic or operational fixes

• Helps to improve overall claims performance to ensure claims are processed accurately and timely

• Identifies claims requiring reprocessing or re-adjudication in a timely manner to ensure compliance

• Works closely with external departments to define claims requirements

• Recommends updates to Claims SOP's and Job Aid's to increase the quality and efficiency of claims processing

• Fields claims questions from Molina Operations teams

• Interprets, communicates, and presents, clear in-depth analysis of claims research results, root cause analysis, remediation plans and fixes, overall progress, and status of impacted claims

• Provides excellent customer services to our internal operations teams concerning claims projects

• Appropriately convey information and tailor communication based on the targeted audience

• Provides sufficient claims information to our internal operations teams that must communicate externally to provider or members

• Able to work in a project team setting while also able to complete tasks individually within the provided timeline or as needed, accelerated timeline to minimize provider/member impacts and/or maintain compliance

• Manages work assignments and prioritization appropriately

• Other duties as assigned.

Job Qualifications

REQUIRED EDUCATION:

Associate's degree or equivalent combination of education and experience

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 1-3 years claims analysis experience

• 5+ years medical claims processing experience across multiple states, markets, and claim types

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

• Knowledge and experience using Excel

PREFERRED EDUCATION:

Bachelor's Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE:

• 1-3 years claims analysis

• 6+ years medical claims processing experience

• Project management

• Expert in Excel and PowerPoint

PHYSICAL DEMANDS:

Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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

#LI-AC1

Pay Range: $17.85 - $38.69 / 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

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.

KNOWLEDGE/SKILLS/ABILITIES

• Analyze and interpret data to determine appropriate configuration changes.

• Accurately interprets specific state and/or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters.

• Handles coding, updating and maintaining benefit plans, provider contracts, fee schedules and various system tables through the user interface.

• Apply previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system(s) as necessary.

• Works with fluctuating volumes of work and is able to prioritize work to meet deadlines and needs of user community.

• Must be able to do deep dive root cause analysis and research on claims

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

2-5 years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

5-7 years

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

Serves as claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are appropriately applied. Manages and leads major claims projects of considerable complexity and volume that may be initiated through provider inquiries or complaints, legal requests, or identified internally by Molina. Identifies the root cause of processing errors through research and analysis, coordinates and engages with appropriate departments, develops and tracks remediation plans, and monitors claims reprocessing through resolution. Interprets and presents in-depth analysis of findings and results to leadership and respective operations teams. Responsible for ensuring the projects are completed accurately and timely.

Job Duties

• Uses analytical skills to conducts research and analysis for issues, requests, and inquiries of high priority claims projects

• Assists with reducing re-work by identifying and remediating claims processing issues

• Locate and interpret regulatory and contractual requirements

• Tailors existing reports or available data to meet the needs of the claims project

• Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing errors

• Applies claims processing and technical knowledge to appropriately define a path for short/long term systematic or operational fixes

• Helps to improve overall claims performance to ensure claims are processed accurately and timely

• Identifies claims requiring reprocessing or re-adjudication in a timely manner to ensure compliance

• Works closely with external departments to define claims requirements

• Recommends updates to Claims SOP's and Job Aid's to increase the quality and efficiency of claims processing

• Fields claims questions from Molina Operations teams

• Interprets, communicates, and presents, clear in-depth analysis of claims research results, root cause analysis, remediation plans and fixes, overall progress, and status of impacted claims

• Provides excellent customer services to our internal operations teams concerning claims projects

• Appropriately convey information and tailor communication based on the targeted audience

• Provides sufficient claims information to our internal operations teams that must communicate externally to provider or members

• Able to work in a project team setting while also able to complete tasks individually within the provided timeline or as needed, accelerated timeline to minimize provider/member impacts and/or maintain compliance

• Manages work assignments and prioritization appropriately

• Other duties as assigned.

Job Qualifications

REQUIRED EDUCATION:

Associate's degree or equivalent combination of education and experience

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 1-3 years claims analysis experience

• 5+ years medical claims processing experience across multiple states, markets, and claim types

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

• Knowledge and experience using Excel

PREFERRED EDUCATION:

Bachelor's Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE:

• 1-3 years claims analysis

• 6+ years medical claims processing experience

• Project management

• Expert in Excel and PowerPoint

PHYSICAL DEMANDS:

Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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

#LI-AC1

Pay Range: $17.85 - $38.69 / 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

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.

KNOWLEDGE/SKILLS/ABILITIES

• Analyze and interpret data to determine appropriate configuration changes.

• Accurately interprets specific state and/or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters.

• Handles coding, updating and maintaining benefit plans, provider contracts, fee schedules and various system tables through the user interface.

• Apply previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system(s) as necessary.

• Works with fluctuating volumes of work and is able to prioritize work to meet deadlines and needs of user community.

• Must be able to do deep dive root cause analysis and research on claims

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

2-5 years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

5-7 years

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

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

The Sr Video Producer manages and elevates the brand of all entities under the Molina Healthcare and the MolinaCares Accord name, providing the video production for all brand-related projects.

Job Duties

1. Conceptualize, produce, and edit videos from internal clients and external vendors. This includes video production, editing, graphics, animation and working with subject matter experts for specific content types.

2. Establish and maintain a high-quality bar such that final deliverables maintain the appropriate production values, voice, and tone

3. Prepare files for broadcasting and electronic distribution

4. Assist with storytelling, which includes composition, framing, timing, visual, communication, narrative, and motion design principles as needed

5. Determine format, style, and length of video content (live action, animation, talking heads, voice overs, audio etc.), for each project's purpose.

6. Work with editorial, social, and marketing to ensure project goals are achieved on time and within budget

7. Track trends in video content, approaches, styles, and technology, and suggest ways to implement them when and where they make sense for Molina Healthcare

8. Ensure the Molina brand guidelines if adhered to for all videos

9. Work with outside agencies that support Molina Healthcare and MolinaCares Accord to uphold brand standards, review creative materials, design templates for vendors and meet with them as need to ensure best practices for the brand is being met

10. Manage project workload by using the marketing project management tool to organize, update and communicate on all projects and archive all completed design files and materials

11. Supports and collaborates with Marketing and Sales to create modern, clean, inviting, and dynamic designs that elevates and upholds the brand guidelines while driving and influencing member acquisition and retention

12. Performs other duties or special projects as assigned

Job Qualifications

Required Qualifications:

• Bachelor's degree or equivalent experience

• 5-7 years providing effective Video production services in a corporate communication and/or private public relations/advertising firm preferred

• 5-7 years of experience interpreting and meeting client requests for design services preferred

• Knowledge of both Mac and PC operating systems.

• Proficient with Microsoft PowerPoint

• Highly proficient in Adobe Creative Suite and Microsoft Office

• Highly Proficient in video editing and postproduction applications.

• Excellent communications skills

Preferred Qualifications:

• Bachelor's degree in Audiovisual Communications, Film and Media or related field preferred

Travel Requirements:

Driving: 10 to 20%, may be required for some on-site video production (depending on location) Air Travel: 10 to 20%, may be required for some on-site video production (depending on location)

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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 Sr Video Producer manages and elevates the brand of all entities under the Molina Healthcare and the MolinaCares Accord name, providing the video production for all brand-related projects.

Job Duties

1. Conceptualize, produce, and edit videos from internal clients and external vendors. This includes video production, editing, graphics, animation and working with subject matter experts for specific content types.

2. Establish and maintain a high-quality bar such that final deliverables maintain the appropriate production values, voice, and tone

3. Prepare files for broadcasting and electronic distribution

4. Assist with storytelling, which includes composition, framing, timing, visual, communication, narrative, and motion design principles as needed

5. Determine format, style, and length of video content (live action, animation, talking heads, voice overs, audio etc.), for each project's purpose.

6. Work with editorial, social, and marketing to ensure project goals are achieved on time and within budget

7. Track trends in video content, approaches, styles, and technology, and suggest ways to implement them when and where they make sense for Molina Healthcare

8. Ensure the Molina brand guidelines if adhered to for all videos

9. Work with outside agencies that support Molina Healthcare and MolinaCares Accord to uphold brand standards, review creative materials, design templates for vendors and meet with them as need to ensure best practices for the brand is being met

10. Manage project workload by using the marketing project management tool to organize, update and communicate on all projects and archive all completed design files and materials

11. Supports and collaborates with Marketing and Sales to create modern, clean, inviting, and dynamic designs that elevates and upholds the brand guidelines while driving and influencing member acquisition and retention

12. Performs other duties or special projects as assigned

Job Qualifications

Required Qualifications:

• Bachelor's degree or equivalent experience

• 5-7 years providing effective Video production services in a corporate communication and/or private public relations/advertising firm preferred

• 5-7 years of experience interpreting and meeting client requests for design services preferred

• Knowledge of both Mac and PC operating systems.

• Proficient with Microsoft PowerPoint

• Highly proficient in Adobe Creative Suite and Microsoft Office

• Highly Proficient in video editing and postproduction applications.

• Excellent communications skills

Preferred Qualifications:

• Bachelor's degree in Audiovisual Communications, Film and Media or related field preferred

Travel Requirements:

Driving: 10 to 20%, may be required for some on-site video production (depending on location) Air Travel: 10 to 20%, may be required for some on-site video production (depending on location)

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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

For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. COMPACT RN LICENSURE IS REQUIRED to support multiple states.

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. Virtual office skills are necessary to be collaborative between team members using MS Teams, videoconference, voice conferencing and email/ chat communications. This is a fast-paced position and productivity is important. Home office with private desk area, and high-speed internet connectivity required.

WORK HOURS: TUESDAY THROUGH SATURDAY 10:00AM to 7:00PM CENTRAL, with some holidays. Candidates who do not live in Central Time Zone must work Central hours as stated.

This department operates 365 days a year and we need staff who can be flexible to work some holidays. Please consider this before applying to this role. This is a remote position, work from home.

Further Details to be discussed during our interview process.

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

• Processes requests within required timelines.

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

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

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

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

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

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

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

State Specific Requirements:

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

The Analyst, Clinical Policy reviews and evaluating existing clinical policies, proposes suggested improvements to existing clinical policies, and researches new policies. Creates reports and analyzes market trends. Improves existing department processes.

KNOWLEDGE/SKILLS/ABILITIES

• Proficiency in clinical policy through skills in literature searching and clinical research analysis based on the best available evidence or via direct work experience.

• Working knowledge of clinical policies.

• Understanding of the managed care industry and market conditions.

• High organizational and time-management skills; ability to work independently.

• Excellent and clear written and verbal communication skills.

• Strong analytical and problem-solving skills.

• Ability to work in a cross-functional, professional environment.

• Exceptional team player with a strong ability to contribute positively to a team environment with a desire to learn, grow, and empower.

• Ability to perform independent research on complex medical topics.

JOB QUALIFICATIONS

Preferred Experience:

• Clinical experience, nursing, therapy, social work background

• Experience writing clinical policy

• Knowledge of NCQA regulations

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

The Sr Video Producer manages and elevates the brand of all entities under the Molina Healthcare and the MolinaCares Accord name, providing the video production for all brand-related projects.

Job Duties

1. Conceptualize, produce, and edit videos from internal clients and external vendors. This includes video production, editing, graphics, animation and working with subject matter experts for specific content types.

2. Establish and maintain a high-quality bar such that final deliverables maintain the appropriate production values, voice, and tone

3. Prepare files for broadcasting and electronic distribution

4. Assist with storytelling, which includes composition, framing, timing, visual, communication, narrative, and motion design principles as needed

5. Determine format, style, and length of video content (live action, animation, talking heads, voice overs, audio etc.), for each project's purpose.

6. Work with editorial, social, and marketing to ensure project goals are achieved on time and within budget

7. Track trends in video content, approaches, styles, and technology, and suggest ways to implement them when and where they make sense for Molina Healthcare

8. Ensure the Molina brand guidelines if adhered to for all videos

9. Work with outside agencies that support Molina Healthcare and MolinaCares Accord to uphold brand standards, review creative materials, design templates for vendors and meet with them as need to ensure best practices for the brand is being met

10. Manage project workload by using the marketing project management tool to organize, update and communicate on all projects and archive all completed design files and materials

11. Supports and collaborates with Marketing and Sales to create modern, clean, inviting, and dynamic designs that elevates and upholds the brand guidelines while driving and influencing member acquisition and retention

12. Performs other duties or special projects as assigned

Job Qualifications

Required Qualifications:

• Bachelor's degree or equivalent experience

• 5-7 years providing effective Video production services in a corporate communication and/or private public relations/advertising firm preferred

• 5-7 years of experience interpreting and meeting client requests for design services preferred

• Knowledge of both Mac and PC operating systems.

• Proficient with Microsoft PowerPoint

• Highly proficient in Adobe Creative Suite and Microsoft Office

• Highly Proficient in video editing and postproduction applications.

• Excellent communications skills

Preferred Qualifications:

• Bachelor's degree in Audiovisual Communications, Film and Media or related field preferred

Travel Requirements:

Driving: 10 to 20%, may be required for some on-site video production (depending on location) Air Travel: 10 to 20%, may be required for some on-site video production (depending on location)

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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

For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. COMPACT RN LICENSURE IS REQUIRED to support multiple states.

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. Virtual office skills are necessary to be collaborative between team members using MS Teams, videoconference, voice conferencing and email/ chat communications. This is a fast-paced position and productivity is important. Home office with private desk area, and high-speed internet connectivity required.

WORK HOURS: TUESDAY THROUGH SATURDAY 10:00AM to 7:00PM CENTRAL, with some holidays. Candidates who do not live in Central Time Zone must work Central hours as stated.

This department operates 365 days a year and we need staff who can be flexible to work some holidays. Please consider this before applying to this role. This is a remote position, work from home.

Further Details to be discussed during our interview process.

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

• Processes requests within required timelines.

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

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

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

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

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

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

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

State Specific Requirements:

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

The Sr Video Producer manages and elevates the brand of all entities under the Molina Healthcare and the MolinaCares Accord name, providing the video production for all brand-related projects.

Job Duties

1. Conceptualize, produce, and edit videos from internal clients and external vendors. This includes video production, editing, graphics, animation and working with subject matter experts for specific content types.

2. Establish and maintain a high-quality bar such that final deliverables maintain the appropriate production values, voice, and tone

3. Prepare files for broadcasting and electronic distribution

4. Assist with storytelling, which includes composition, framing, timing, visual, communication, narrative, and motion design principles as needed

5. Determine format, style, and length of video content (live action, animation, talking heads, voice overs, audio etc.), for each project's purpose.

6. Work with editorial, social, and marketing to ensure project goals are achieved on time and within budget

7. Track trends in video content, approaches, styles, and technology, and suggest ways to implement them when and where they make sense for Molina Healthcare

8. Ensure the Molina brand guidelines if adhered to for all videos

9. Work with outside agencies that support Molina Healthcare and MolinaCares Accord to uphold brand standards, review creative materials, design templates for vendors and meet with them as need to ensure best practices for the brand is being met

10. Manage project workload by using the marketing project management tool to organize, update and communicate on all projects and archive all completed design files and materials

11. Supports and collaborates with Marketing and Sales to create modern, clean, inviting, and dynamic designs that elevates and upholds the brand guidelines while driving and influencing member acquisition and retention

12. Performs other duties or special projects as assigned

Job Qualifications

Required Qualifications:

• Bachelor's degree or equivalent experience

• 5-7 years providing effective Video production services in a corporate communication and/or private public relations/advertising firm preferred

• 5-7 years of experience interpreting and meeting client requests for design services preferred

• Knowledge of both Mac and PC operating systems.

• Proficient with Microsoft PowerPoint

• Highly proficient in Adobe Creative Suite and Microsoft Office

• Highly Proficient in video editing and postproduction applications.

• Excellent communications skills

Preferred Qualifications:

• Bachelor's degree in Audiovisual Communications, Film and Media or related field preferred

Travel Requirements:

Driving: 10 to 20%, may be required for some on-site video production (depending on location) Air Travel: 10 to 20%, may be required for some on-site video production (depending on location)

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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

For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. COMPACT RN LICENSURE IS REQUIRED to support multiple states.

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. Virtual office skills are necessary to be collaborative between team members using MS Teams, videoconference, voice conferencing and email/ chat communications. This is a fast-paced position and productivity is important. Home office with private desk area, and high-speed internet connectivity required.

WORK HOURS: TUESDAY THROUGH SATURDAY 10:00AM to 7:00PM CENTRAL, with some holidays. Candidates who do not live in Central Time Zone must work Central hours as stated.

This department operates 365 days a year and we need staff who can be flexible to work some holidays. Please consider this before applying to this role. This is a remote position, work from home.

Further Details to be discussed during our interview process.

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

• Processes requests within required timelines.

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

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

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

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

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

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

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

State Specific Requirements:

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

The Sr Video Producer manages and elevates the brand of all entities under the Molina Healthcare and the MolinaCares Accord name, providing the video production for all brand-related projects.

Job Duties

1. Conceptualize, produce, and edit videos from internal clients and external vendors. This includes video production, editing, graphics, animation and working with subject matter experts for specific content types.

2. Establish and maintain a high-quality bar such that final deliverables maintain the appropriate production values, voice, and tone

3. Prepare files for broadcasting and electronic distribution

4. Assist with storytelling, which includes composition, framing, timing, visual, communication, narrative, and motion design principles as needed

5. Determine format, style, and length of video content (live action, animation, talking heads, voice overs, audio etc.), for each project's purpose.

6. Work with editorial, social, and marketing to ensure project goals are achieved on time and within budget

7. Track trends in video content, approaches, styles, and technology, and suggest ways to implement them when and where they make sense for Molina Healthcare

8. Ensure the Molina brand guidelines if adhered to for all videos

9. Work with outside agencies that support Molina Healthcare and MolinaCares Accord to uphold brand standards, review creative materials, design templates for vendors and meet with them as need to ensure best practices for the brand is being met

10. Manage project workload by using the marketing project management tool to organize, update and communicate on all projects and archive all completed design files and materials

11. Supports and collaborates with Marketing and Sales to create modern, clean, inviting, and dynamic designs that elevates and upholds the brand guidelines while driving and influencing member acquisition and retention

12. Performs other duties or special projects as assigned

Job Qualifications

Required Qualifications:

• Bachelor's degree or equivalent experience

• 5-7 years providing effective Video production services in a corporate communication and/or private public relations/advertising firm preferred

• 5-7 years of experience interpreting and meeting client requests for design services preferred

• Knowledge of both Mac and PC operating systems.

• Proficient with Microsoft PowerPoint

• Highly proficient in Adobe Creative Suite and Microsoft Office

• Highly Proficient in video editing and postproduction applications.

• Excellent communications skills

Preferred Qualifications:

• Bachelor's degree in Audiovisual Communications, Film and Media or related field preferred

Travel Requirements:

Driving: 10 to 20%, may be required for some on-site video production (depending on location) Air Travel: 10 to 20%, may be required for some on-site video production (depending on location)

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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

For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. COMPACT RN LICENSURE IS REQUIRED to support multiple states.

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. Virtual office skills are necessary to be collaborative between team members using MS Teams, videoconference, voice conferencing and email/ chat communications. This is a fast-paced position and productivity is important. Home office with private desk area, and high-speed internet connectivity required.

WORK HOURS: TUESDAY THROUGH SATURDAY 10:00AM to 7:00PM CENTRAL, with some holidays. Candidates who do not live in Central Time Zone must work Central hours as stated.

This department operates 365 days a year and we need staff who can be flexible to work some holidays. Please consider this before applying to this role. This is a remote position, work from home.

Further Details to be discussed during our interview process.

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

• Processes requests within required timelines.

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

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

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

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

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

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

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

State Specific Requirements:

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

The Sr Video Producer manages and elevates the brand of all entities under the Molina Healthcare and the MolinaCares Accord name, providing the video production for all brand-related projects.

Job Duties

1. Conceptualize, produce, and edit videos from internal clients and external vendors. This includes video production, editing, graphics, animation and working with subject matter experts for specific content types.

2. Establish and maintain a high-quality bar such that final deliverables maintain the appropriate production values, voice, and tone

3. Prepare files for broadcasting and electronic distribution

4. Assist with storytelling, which includes composition, framing, timing, visual, communication, narrative, and motion design principles as needed

5. Determine format, style, and length of video content (live action, animation, talking heads, voice overs, audio etc.), for each project's purpose.

6. Work with editorial, social, and marketing to ensure project goals are achieved on time and within budget

7. Track trends in video content, approaches, styles, and technology, and suggest ways to implement them when and where they make sense for Molina Healthcare

8. Ensure the Molina brand guidelines if adhered to for all videos

9. Work with outside agencies that support Molina Healthcare and MolinaCares Accord to uphold brand standards, review creative materials, design templates for vendors and meet with them as need to ensure best practices for the brand is being met

10. Manage project workload by using the marketing project management tool to organize, update and communicate on all projects and archive all completed design files and materials

11. Supports and collaborates with Marketing and Sales to create modern, clean, inviting, and dynamic designs that elevates and upholds the brand guidelines while driving and influencing member acquisition and retention

12. Performs other duties or special projects as assigned

Job Qualifications

Required Qualifications:

• Bachelor's degree or equivalent experience

• 5-7 years providing effective Video production services in a corporate communication and/or private public relations/advertising firm preferred

• 5-7 years of experience interpreting and meeting client requests for design services preferred

• Knowledge of both Mac and PC operating systems.

• Proficient with Microsoft PowerPoint

• Highly proficient in Adobe Creative Suite and Microsoft Office

• Highly Proficient in video editing and postproduction applications.

• Excellent communications skills

Preferred Qualifications:

• Bachelor's degree in Audiovisual Communications, Film and Media or related field preferred

Travel Requirements:

Driving: 10 to 20%, may be required for some on-site video production (depending on location) Air Travel: 10 to 20%, may be required for some on-site video production (depending on location)

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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

For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. COMPACT RN LICENSURE IS REQUIRED to support multiple states.

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. Virtual office skills are necessary to be collaborative between team members using MS Teams, videoconference, voice conferencing and email/ chat communications. This is a fast-paced position and productivity is important. Home office with private desk area, and high-speed internet connectivity required.

WORK HOURS: TUESDAY THROUGH SATURDAY 10:00AM to 7:00PM CENTRAL, with some holidays. Candidates who do not live in Central Time Zone must work Central hours as stated.

This department operates 365 days a year and we need staff who can be flexible to work some holidays. Please consider this before applying to this role. This is a remote position, work from home.

Further Details to be discussed during our interview process.

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

• Processes requests within required timelines.

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

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

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

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

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

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

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

State Specific Requirements:

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. COMPACT RN LICENSURE IS REQUIRED to support multiple states.

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. Virtual office skills are necessary to be collaborative between team members using MS Teams, videoconference, voice conferencing and email/ chat communications. This is a fast-paced position and productivity is important. Home office with private desk area, and high-speed internet connectivity required.

WORK HOURS: TUESDAY THROUGH SATURDAY 10:00AM to 7:00PM CENTRAL, with some holidays. Candidates who do not live in Central Time Zone must work Central hours as stated.

This department operates 365 days a year and we need staff who can be flexible to work some holidays. Please consider this before applying to this role. This is a remote position, work from home.

Further Details to be discussed during our interview process.

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

• Processes requests within required timelines.

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

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

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

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

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

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

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

State Specific Requirements:

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

Serves as claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are appropriately applied. Manages and leads major claims projects of considerable complexity and volume that may be initiated through provider inquiries or complaints, legal requests, or identified internally by Molina. Identifies the root cause of processing errors through research and analysis, coordinates and engages with appropriate departments, develops and tracks remediation plans, and monitors claims reprocessing through resolution. Interprets and presents in-depth analysis of findings and results to leadership and respective operations teams. Responsible for ensuring the projects are completed accurately and timely.

Job Duties

• Uses analytical skills to conducts research and analysis for issues, requests, and inquiries of high priority claims projects

• Assists with reducing re-work by identifying and remediating claims processing issues

• Locate and interpret regulatory and contractual requirements

• Tailors existing reports or available data to meet the needs of the claims project

• Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing errors

• Applies claims processing and technical knowledge to appropriately define a path for short/long term systematic or operational fixes

• Helps to improve overall claims performance to ensure claims are processed accurately and timely

• Identifies claims requiring reprocessing or re-adjudication in a timely manner to ensure compliance

• Works closely with external departments to define claims requirements

• Recommends updates to Claims SOP's and Job Aid's to increase the quality and efficiency of claims processing

• Fields claims questions from Molina Operations teams

• Interprets, communicates, and presents, clear in-depth analysis of claims research results, root cause analysis, remediation plans and fixes, overall progress, and status of impacted claims

• Provides excellent customer services to our internal operations teams concerning claims projects

• Appropriately convey information and tailor communication based on the targeted audience

• Provides sufficient claims information to our internal operations teams that must communicate externally to provider or members

• Able to work in a project team setting while also able to complete tasks individually within the provided timeline or as needed, accelerated timeline to minimize provider/member impacts and/or maintain compliance

• Manages work assignments and prioritization appropriately

• Other duties as assigned.

Job Qualifications

REQUIRED EDUCATION:

Associate's degree or equivalent combination of education and experience

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 1-3 years claims analysis experience

• 5+ years medical claims processing experience across multiple states, markets, and claim types

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

• Knowledge and experience using Excel

PREFERRED EDUCATION:

Bachelor's Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE:

• 1-3 years claims analysis

• 6+ years medical claims processing experience

• Project management

• Expert in Excel and PowerPoint

PHYSICAL DEMANDS:

Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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

#LI-AC1

Pay Range: $17.85 - $38.69 / 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 Analyst, Clinical Policy reviews and evaluating existing clinical policies, proposes suggested improvements to existing clinical policies, and researches new policies. Creates reports and analyzes market trends. Improves existing department processes.

KNOWLEDGE/SKILLS/ABILITIES

• Proficiency in clinical policy through skills in literature searching and clinical research analysis based on the best available evidence or via direct work experience.

• Working knowledge of clinical policies.

• Understanding of the managed care industry and market conditions.

• High organizational and time-management skills; ability to work independently.

• Excellent and clear written and verbal communication skills.

• Strong analytical and problem-solving skills.

• Ability to work in a cross-functional, professional environment.

• Exceptional team player with a strong ability to contribute positively to a team environment with a desire to learn, grow, and empower.

• Ability to perform independent research on complex medical topics.

JOB QUALIFICATIONS

Preferred Experience:

• Clinical experience, nursing, therapy, social work background

• Experience writing clinical policy

• Knowledge of NCQA regulations

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

The Sr Video Producer manages and elevates the brand of all entities under the Molina Healthcare and the MolinaCares Accord name, providing the video production for all brand-related projects.

Job Duties

1. Conceptualize, produce, and edit videos from internal clients and external vendors. This includes video production, editing, graphics, animation and working with subject matter experts for specific content types.

2. Establish and maintain a high-quality bar such that final deliverables maintain the appropriate production values, voice, and tone

3. Prepare files for broadcasting and electronic distribution

4. Assist with storytelling, which includes composition, framing, timing, visual, communication, narrative, and motion design principles as needed

5. Determine format, style, and length of video content (live action, animation, talking heads, voice overs, audio etc.), for each project's purpose.

6. Work with editorial, social, and marketing to ensure project goals are achieved on time and within budget

7. Track trends in video content, approaches, styles, and technology, and suggest ways to implement them when and where they make sense for Molina Healthcare

8. Ensure the Molina brand guidelines if adhered to for all videos

9. Work with outside agencies that support Molina Healthcare and MolinaCares Accord to uphold brand standards, review creative materials, design templates for vendors and meet with them as need to ensure best practices for the brand is being met

10. Manage project workload by using the marketing project management tool to organize, update and communicate on all projects and archive all completed design files and materials

11. Supports and collaborates with Marketing and Sales to create modern, clean, inviting, and dynamic designs that elevates and upholds the brand guidelines while driving and influencing member acquisition and retention

12. Performs other duties or special projects as assigned

Job Qualifications

Required Qualifications:

• Bachelor's degree or equivalent experience

• 5-7 years providing effective Video production services in a corporate communication and/or private public relations/advertising firm preferred

• 5-7 years of experience interpreting and meeting client requests for design services preferred

• Knowledge of both Mac and PC operating systems.

• Proficient with Microsoft PowerPoint

• Highly proficient in Adobe Creative Suite and Microsoft Office

• Highly Proficient in video editing and postproduction applications.

• Excellent communications skills

Preferred Qualifications:

• Bachelor's degree in Audiovisual Communications, Film and Media or related field preferred

Travel Requirements:

Driving: 10 to 20%, may be required for some on-site video production (depending on location) Air Travel: 10 to 20%, may be required for some on-site video production (depending on location)

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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

For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. COMPACT RN LICENSURE IS REQUIRED to support multiple states.

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. Virtual office skills are necessary to be collaborative between team members using MS Teams, videoconference, voice conferencing and email/ chat communications. This is a fast-paced position and productivity is important. Home office with private desk area, and high-speed internet connectivity required.

WORK HOURS: TUESDAY THROUGH SATURDAY 10:00AM to 7:00PM CENTRAL, with some holidays. Candidates who do not live in Central Time Zone must work Central hours as stated.

This department operates 365 days a year and we need staff who can be flexible to work some holidays. Please consider this before applying to this role. This is a remote position, work from home.

Further Details to be discussed during our interview process.

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

• Processes requests within required timelines.

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

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

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

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

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

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

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

State Specific Requirements:

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. COMPACT RN LICENSURE IS REQUIRED to support multiple states.

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. Virtual office skills are necessary to be collaborative between team members using MS Teams, videoconference, voice conferencing and email/ chat communications. This is a fast-paced position and productivity is important. Home office with private desk area, and high-speed internet connectivity required.

WORK HOURS: TUESDAY THROUGH SATURDAY 10:00AM to 7:00PM CENTRAL, with some holidays. Candidates who do not live in Central Time Zone must work Central hours as stated.

This department operates 365 days a year and we need staff who can be flexible to work some holidays. Please consider this before applying to this role. This is a remote position, work from home.

Further Details to be discussed during our interview process.

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

• Processes requests within required timelines.

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

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

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

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

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

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

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

State Specific Requirements:

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. COMPACT RN LICENSURE IS REQUIRED to support multiple states.

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. Virtual office skills are necessary to be collaborative between team members using MS Teams, videoconference, voice conferencing and email/ chat communications. This is a fast-paced position and productivity is important. Home office with private desk area, and high-speed internet connectivity required.

WORK HOURS: TUESDAY THROUGH SATURDAY 10:00AM to 7:00PM CENTRAL, with some holidays. Candidates who do not live in Central Time Zone must work Central hours as stated.

This department operates 365 days a year and we need staff who can be flexible to work some holidays. Please consider this before applying to this role. This is a remote position, work from home.

Further Details to be discussed during our interview process.

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

• Processes requests within required timelines.

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

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

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

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

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

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

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

State Specific Requirements:

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

We are seeking a CASE MANAGER for our NEW MEXICO Health Plan. Candidates must live in MCKINLEY 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 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

Job Description

JOB DESCRIPTION

*This role is remote and employee must reside in Florida**

Job Summary

Claims Adjuster/Adjudicator is responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards.

KNOWLEDGE/SKILLS/ABILITIES

• Researches tracers, adjustments, and re-submissions.

• Handles basic projects as assigned.

• Assists with defect reduction by identifying and communicating error issues and potential solutions to management.

• Helps to improve overall performance accountability (attendance, communication, flexibility, adaptability, interpersonal skills, teamwork and cooperation).

• Adjudicates or re-adjudicate claims in a timely manner to ensure compliance to departmental turn-around time and quality standards.

• Meets department quality and production standards.

• Other duties as assigned.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

1-3 Years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

3-5 years

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: $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