Company Detail

Job Description

Job Description

Job Summary

As the Senior Consultant, Threat Management PSOC, you will be a member of Molina Healthcare's Protection Services Operations Center, reporting to the Manager. This role will be responsible for executing and managing physical security, threat, and incident intake and management for the enterprise. This role will liaise with all employees to address security issues or incidents that arise in the field or Molina offices. Activities will ensure alignment with policies, standard and procedures in deliverables. Additionally, this person will support incident response and crisis management activities during disruptive events as needed.

Knowledge/Skills/Abilities

• Supports the Protection Services Operations Center in responding to and abating workplace violence and physical threat incidents.

• Rapid responses (in a remote environment) to workforce members involved in workplace violence incidents, threat events, and distressed situations.

• Engages high-stress situations to ensure incident response, threat abatement, and after-care support for involved workforce members and/or company facilities.

• Interviewing workforce members who have experienced threat events or distressed situations; interviewing witnesses; coordinating law enforcement / emergency responses; and preparing either comprehensive reports and case files.

• Provides comprehensive intelligence on threat actors, including but not limited to comprehensive reviews of an actor's bio, court history, criminal history, and social media activity,

• Serve as a law enforcement liaison on a range of responsibilities, including rapid incident response coordination and LE support requests.

• Support in coordinating/scheduling close protection agents for select field and company events.

• Support in developing and facilitating training on a range of workplace violence topics, including field security best practices and active shooter survival training.

• May be required to work outside of normal business hours (nights, evenings, and weekends) if responding to emergencies

• Perform other duties as assigned

Job Qualifications

Required Education:

• Bachelor's degree or equivalent professional work experience

Required Experience:

• Minimum 8+ years demonstrated experience in physical security, threat intelligence and/or security operations with comprehensive understanding of practice, principles and processes

Required Knowledge, Skills and Abilities:

You are

• Excellent report writing and case management skills.

• Excellent communication and interpersonal skills.

• Strong analytical and research skills.

• Proficiency with Microsoft Office suite.

• Ability to work under pressure.

• Ability to regularly work after hours and adjust work schedule as needed during threat events.

• Experience coordinating with law enforcement at a regional or national level.

• Ability to deal with high stress situations.

• Healthcare / HIPAA experience a strong plus.

You have a deep understanding of:

• The candidate should have a strong grasp of physical security and security operations:

• Access control systems

• Surveillance systems

• Intrusion systems

• Ticketing and workflow management to ensure SLAs

• Metrics, reporting and analysis

• Extensive experience with Lenel, Avigilon, Envoy, and Everbridge (including VCC, Notification and SafetyConnect).

• Software skills & competencies are required, as well as internet research abilities and strong communication skills. Includes: MS Office (Outlook, Word, Excel, and PowerPoint) and also preferably a familiarity with SharePoint and Visio

• Excellent knowledge of physical security and security operations best practices, policies, and procedures

• Strong project management skills

• Familiarity with best practices and standards for physical security

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: $54,373.27 - $117,808.76 / 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

The Community Connector will be working 100% remote in an outbound call environment (Must reside in the state of VA). Our Community Connectors will be working with our VA Medicaid newly enrolled members referred to us by Department Social Services. This individual will be making outbound calls to our newly enrolled members to make first point contact, complete health screener and answer any member questions. We are looking for candidates with outbound call center experience, excellence customer services, and ability to toggle back and forth between multiple screens and databases.

Home office with internet connectivity of high speed required.

Monday - Friday 8 AM to 5 PM EST (No weekends or Holidays)

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

• Serves as a community based member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing their healthcare needs.

• Collaborates with and supports the Healthcare Services team by providing non-clinical paraprofessional duties in the field, to include meeting with members in their homes, nursing homes, shelters, or doctor's offices, etc.

• Empowers members by helping them navigate and maximize their health plan benefits.

• Assistance may include: scheduling appointments with providers; arranging transportation for healthcare visits; getting prescriptions filled; and following up with members on missed appointments.

• Assists members in accessing social services such as community-based resources for housing, food, employment, etc.

• Provides outreach to locate and/or provide support for disconnected members with special needs.

• Conducts research with available data to locate members Molina Healthcare has been unable to contact (e.g., reviewing internal databases, contacting member providers or caregivers, or travel to last known address or community resource locations such as homeless shelters, etc.)

• Participates in ongoing or project-based activities that may require extensive member outreach (telephonically and/or face-to-face).

• Guides members to maintain Medicaid eligibility and with other financial resources as appropriate.

• 50-80% local travel may be required. Reliable transportation required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

HS Diploma/GED

REQUIRED EXPERIENCE:

- Minimum 1 year experience working with underserved or special needs populations, with varied health, economic and educational circumstances.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

- For Ohio, Florida, and California only -- Active and unrestricted Community Health Worker (CHW) Certification.

PREFERRED EDUCATION:

Associate's Degree in a health care related field (e.g., nutrition, counseling, social work).

PREFERRED EXPERIENCE:

- Bilingual based on community need.

- Familiarity with healthcare systems a plus.

- Knowledge of community-specific culture.

- Experience with or knowledge of health care basics, community resources, social services, and/or health education.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

- Current Community Health Worker (CHW) Certification preferred (for states other than Ohio, Florida and California, where it is required).

- Active and unrestricted Medical Assistant Certification

STATE SPECIFIC REQUIREMENTS: OHIO

- MHO Care Guide serves as a single point of contact for care coordination when there is no CCE, OhioRISE Plan, and/or CME involvement and short term care coordination needs are identified MHO Care Guide Plus serves as a single point of contact at Molina for care coordination when there is CCE, OhioRISE Plan, and/or CME involvement and short term care coordination needs are identified.

- Assures completion of a health risk assessment, assisting members to remediate immediate and acute gaps in care and access. Assist members with filing grievances and appeals.

- Connects members to CCEs, the OhioRISE Plan,or Molina Care Management if the members needs indicate a higher level of coordination. Provide information to members related to Molina requirements , services and benefits .

- Knowledge of internal MCO processes and procedures related to Care Guide responsibilities required

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: $14.76 - $31.97 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Summary

Molina Risk & Quality Solutions (RQS) works with health plan risk & quality leaders to support implementation of best practices for optimal performance. The Program Director, RQS HP Engagement ensures that all RQS action plans are complete, accurate and reflect the needs and path to performance goals.

Knowledge/Skills/Abilities

- Performs the forensic deep dive in risk and quality data solutions to continuously identify opportunities for improvement.

- May supervise one or more Program Managers.

- Serves as industry subject matter expert in the functional areas within RQS and leads programs to meet critical needs.

- Escalates gaps and barriers in implementation and compliance to leadership. Partners with the Execution team for resolutions and barrier removal impeding Health Plan execution.

- Acts in a consultative role, supporting development of business case methodologies for incremental programs. Develops and coordinates implementation of business strategy.

- Collaborates and facilitates activities with other units at corporate and Molina Plans.

Job Qualifications

REQUIRED EDUCATION:

Bachelor's Degree in Healthcare-related field (equivalent combination of education and experience will be considered in lieu of Bachelor's Degree).

REQUIRED EXPERIENCE:

- 7+ years managed healthcare experience with proven relationship management responsibilities

- Proven experience in risk adjustment, quality, and provider engagement.

- Demonstrated ability to lead and influence cross-functional teams

- Excellent communication and presentation skills, communicating to all levels within the organization

- Operational and process improvement experience

PREFERRED EDUCATION:

Master's degree in Business, Health Administration or related field.

PREFERRED EXPERIENCE:

10+ years managed care experience specifically within Risk Adjustment and/or Quality

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

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

As the Senior Consultant, Threat Management PSOC, you will be a member of Molina Healthcare's Protection Services Operations Center, reporting to the Manager. This role will be responsible for executing and managing physical security, threat, and incident intake and management for the enterprise. This role will liaise with all employees to address security issues or incidents that arise in the field or Molina offices. Activities will ensure alignment with policies, standard and procedures in deliverables. Additionally, this person will support incident response and crisis management activities during disruptive events as needed.

Knowledge/Skills/Abilities

• Supports the Protection Services Operations Center in responding to and abating workplace violence and physical threat incidents.

• Rapid responses (in a remote environment) to workforce members involved in workplace violence incidents, threat events, and distressed situations.

• Engages high-stress situations to ensure incident response, threat abatement, and after-care support for involved workforce members and/or company facilities.

• Interviewing workforce members who have experienced threat events or distressed situations; interviewing witnesses; coordinating law enforcement / emergency responses; and preparing either comprehensive reports and case files.

• Provides comprehensive intelligence on threat actors, including but not limited to comprehensive reviews of an actor's bio, court history, criminal history, and social media activity,

• Serve as a law enforcement liaison on a range of responsibilities, including rapid incident response coordination and LE support requests.

• Support in coordinating/scheduling close protection agents for select field and company events.

• Support in developing and facilitating training on a range of workplace violence topics, including field security best practices and active shooter survival training.

• May be required to work outside of normal business hours (nights, evenings, and weekends) if responding to emergencies

• Perform other duties as assigned

Job Qualifications

Required Education:

• Bachelor's degree or equivalent professional work experience

Required Experience:

• Minimum 8+ years demonstrated experience in physical security, threat intelligence and/or security operations with comprehensive understanding of practice, principles and processes

Required Knowledge, Skills and Abilities:

You are

• Excellent report writing and case management skills.

• Excellent communication and interpersonal skills.

• Strong analytical and research skills.

• Proficiency with Microsoft Office suite.

• Ability to work under pressure.

• Ability to regularly work after hours and adjust work schedule as needed during threat events.

• Experience coordinating with law enforcement at a regional or national level.

• Ability to deal with high stress situations.

• Healthcare / HIPAA experience a strong plus.

You have a deep understanding of:

• The candidate should have a strong grasp of physical security and security operations:

• Access control systems

• Surveillance systems

• Intrusion systems

• Ticketing and workflow management to ensure SLAs

• Metrics, reporting and analysis

• Extensive experience with Lenel, Avigilon, Envoy, and Everbridge (including VCC, Notification and SafetyConnect).

• Software skills & competencies are required, as well as internet research abilities and strong communication skills. Includes: MS Office (Outlook, Word, Excel, and PowerPoint) and also preferably a familiarity with SharePoint and Visio

• Excellent knowledge of physical security and security operations best practices, policies, and procedures

• Strong project management skills

• Familiarity with best practices and standards for physical security

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: $54,373.27 - $117,808.76 / ANNUAL

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Responsible for analysis of financial reports, trend, and opportunities. Includes evaluation of and recommendations relating to business opportunities, investments, financial regulations, and similar financial projects or programs. Duties include gathering, interpreting, and evaluating financial information; generating forecasts and analyzes trends in sales, finance and other areas of business; Creating financial models for future business planning decisions in areas such as new product development, new marketing strategies, etc.

KNOWLEDGE/SKILLS/ABILITIES

• Forecasts and monitors economic benefits of Molina investments in infrastructure and operations (enhancements in operating efficiency and effectiveness).

• Allocates limited resources among different investments in infrastructure and operations by ranking based upon economic benefit.

• Analyzes capital equipment purchases. Performs lease vs. buy analyses.

• Assists the IT Technology department with financial modeling, budgeting, benchmarking analysis and variance analysis as needed.

• Develops policies and procedures to support all Finance activities.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree

Required Experience

3-4 Years

Preferred Education

MBA

Preferred Experience

• 5-6 Years

• Preferred License, Certification, Association

• CPA

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

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

Pay Range: $54,373.27 - $117,808.76 / 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

Leads business process improvement initiatives that result in operational efficiencies and/or an increase in customer satisfaction. Assists in development of MHI's business process improvement methodology and in the implementation of a business process improvement capability.

Knowledge/Skills/Abilities

- Defines program scope, establish approach for implementation and maintains program infrastructure

- Develop a method for assessing program effectiveness and a cadence for assessing and adjusting

- Develop approach for communication organizationally about the program

- Determine program support needs

- Gains agreement on process improvement opportunities to be undertaken and assists in the prioritization of approved initiatives/projects.

- Keeps abreast of current trends impacting Lean concepts/methodologies/tools to ensure that best practices are utilized in process improvement efforts.

- Coordinates and collaborates with Molina enterprise Operational Excellence team and health plan Operational Excellence teams

- Ensures appropriate alignment within the program with organizational Operational Excellence programs

- Manages the portfolio of projects, educational programs and coaching plan for the organization

- Develop managers and staff in lean principles, methodology and application through individual coaching, education and projects

- Explains and applies accepted methodologies (i.e. identify desired outcomes, analyze current processes/problems, collect/analyze relevant data, uncover root causes, develop performance/process improvement plan and implementation tactics, test recommendation and assess results.)

- Establish and maintain an education and coaching approach for all levels of staff. Continuously evaluates training and coaching needs of the organization as it relates to process improvement. Develops and maintains the necessary curriculum and supporting materials to education staff and leaders.

- Facilitates Lean improvement workshops in partnership with managers; develops and delivers presentations/education to mentor/coach various key leadership and management staff to promote awareness, understanding, acceptance and engagement of Lean concepts, methodologies and tools.

Job Qualifications

Required Education

Bachelor's degree required in a related field (Business Administration, Healthcare, Engineering, etc.)

Required Experience

- 8 years' experience in healthcare

- 4 years of management level experience

- Understanding of all areas of health plan operations: claims processing, customer service/call center, provider contracting, benefit design and configuration, product development, membership accounting and enrollment, operational systems, provider contracting, authorizations/referrals, utilization management.

- Understands key revenue levers and cost drivers of business processes.

- Understands critical success factors for the industry.

- Experience designing and delivering solutions related to operational improvement functions.

- Strong leadership qualities and ability to get results.

Preferred Education

Graduate Degree

Preferred Experience

- 6 years of healthcare related process improvement experience with demonstrable successes in application of Lean/Six-Sigma

- 10 years of process improvement experience.

• Azure.

• SQL programming experience (read/write SQL).

• Process improvement for Data Governance.

• Healthcare Informatics.

Preferred License, Certification, Association

• LEAN certification and/or Lean Six Sigma Black Belt

• CPHQ certification.To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $96,325.57 - $208,705.4 / 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

The Community Connector will be working 100% remote in an outbound call environment (Must reside in the state of VA). Our Community Connectors will be working with our VA Medicaid newly enrolled members referred to us by Department Social Services. This individual will be making outbound calls to our newly enrolled members to make first point contact, complete health screener and answer any member questions. We are looking for candidates with outbound call center experience, excellence customer services, and ability to toggle back and forth between multiple screens and databases.

Home office with internet connectivity of high speed required.

Monday - Friday 8 AM to 5 PM EST (No weekends or Holidays)

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

• Serves as a community based member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing their healthcare needs.

• Collaborates with and supports the Healthcare Services team by providing non-clinical paraprofessional duties in the field, to include meeting with members in their homes, nursing homes, shelters, or doctor's offices, etc.

• Empowers members by helping them navigate and maximize their health plan benefits.

• Assistance may include: scheduling appointments with providers; arranging transportation for healthcare visits; getting prescriptions filled; and following up with members on missed appointments.

• Assists members in accessing social services such as community-based resources for housing, food, employment, etc.

• Provides outreach to locate and/or provide support for disconnected members with special needs.

• Conducts research with available data to locate members Molina Healthcare has been unable to contact (e.g., reviewing internal databases, contacting member providers or caregivers, or travel to last known address or community resource locations such as homeless shelters, etc.)

• Participates in ongoing or project-based activities that may require extensive member outreach (telephonically and/or face-to-face).

• Guides members to maintain Medicaid eligibility and with other financial resources as appropriate.

• 50-80% local travel may be required. Reliable transportation required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

HS Diploma/GED

REQUIRED EXPERIENCE:

- Minimum 1 year experience working with underserved or special needs populations, with varied health, economic and educational circumstances.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

- For Ohio, Florida, and California only -- Active and unrestricted Community Health Worker (CHW) Certification.

PREFERRED EDUCATION:

Associate's Degree in a health care related field (e.g., nutrition, counseling, social work).

PREFERRED EXPERIENCE:

- Bilingual based on community need.

- Familiarity with healthcare systems a plus.

- Knowledge of community-specific culture.

- Experience with or knowledge of health care basics, community resources, social services, and/or health education.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

- Current Community Health Worker (CHW) Certification preferred (for states other than Ohio, Florida and California, where it is required).

- Active and unrestricted Medical Assistant Certification

STATE SPECIFIC REQUIREMENTS: OHIO

- MHO Care Guide serves as a single point of contact for care coordination when there is no CCE, OhioRISE Plan, and/or CME involvement and short term care coordination needs are identified MHO Care Guide Plus serves as a single point of contact at Molina for care coordination when there is CCE, OhioRISE Plan, and/or CME involvement and short term care coordination needs are identified.

- Assures completion of a health risk assessment, assisting members to remediate immediate and acute gaps in care and access. Assist members with filing grievances and appeals.

- Connects members to CCEs, the OhioRISE Plan,or Molina Care Management if the members needs indicate a higher level of coordination. Provide information to members related to Molina requirements , services and benefits .

- Knowledge of internal MCO processes and procedures related to Care Guide responsibilities required

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: $14.76 - $31.97 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Plans, organizes, staffs, and coordinates the Provider Contracts activities for the state health plan. Works with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider contracts and contracting strategies.

Job Duties

Manages the Plan's Provider Contracting functions and team members. Responsible for leading the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Contracting functions. This role primarily leads negotiations of contracts with the Complex Provider Community that result in high quality, cost effective and marketable providers. Contract/Re-contracting with large scale entities involving custom reimbursement. Executes standardized Alternative Payment Method or Value Based Payment (VBP) contracts. Lead initiatives and activities issue escalations, network adequacy, and Joint Operating Committees.

- Manages and reports network adequacy for Medicare, Marketplace, and Medicaid services.

- In conjunction with direct management and senior leadership, oversees development of provider contracting strategies including VBP. This includes identifying those specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of members and patients in addition to identifying VBP provider targets to meet Molina goals.

- Leads the achievement of annual savings through recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region.

- Leads preparation and negotiations of provider contracts and oversee negotiation of contracts, including VBP, in concert with established company guidelines with physicians, hospitals, and other health care providers.

- Utilizes standardized contract templates and VBP/Pay for Performance strategies.

- Develops and maintains Reimbursement Tolerance Parameters (across multiple specialties/ geographies). Oversees the development of new reimbursement models in concert with direct management and senior leadership/management.

- Communicates new strategies to corporate provider network leadership for input.

- Utilize standardized system(s) to track contract negotiation activity on an ongoing basis throughout the year.

- Participates on the management team and other committees addressing the strategic goals of the department and organization.

- Oversees the maintenance of all Provider Contract templates including VBP program templates. Works with Legal and Corporate Network Management as needed to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.

- Manages the contracting relationships with area agencies and community partners to support and advance Plan initiatives.

- Develops and implements contracting strategies to comply with state, federal, NCQA, HEDIS initiatives and regulations.

- Manages and provides coaching to Network Contracting Staff.

- Manages and evaluates team member performance; provides coaching, consultation, employee development, and recognition; ensures ongoing, appropriate staff training; holds regular team meetings to drive good communication and collaboration; and has responsibility for the selection, orientation and mentoring of new staff.

Job Qualifications

REQUIRED EDUCATION :

Bachelor's Degree in a related field (Business Administration, etc.) or equivalent experience.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

- 7+ years experience in Healthcare Administration, Managed Care, Provider Contracting and/or Provider Services, including 2+ years in a direct or matrix leadership position

- 5+ years experience in provider contract negotiations in a managed healthcare setting including in negotiating different provider contract types and VBP models, i.e. physician, group and hospital contracting, etc.

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

- Min. 2 years experience managing/supervising employees.

PREFERRED EDUCATION :

Master's Degree in a related field or an equivalent combination of education and experience

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

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

Pay Range: $87,568.7 - $189,732.18 / 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

The Community Connector will be working 100% remote in an outbound call environment (Must reside in the state of VA). Our Community Connectors will be working with our VA Medicaid newly enrolled members referred to us by Department Social Services. This individual will be making outbound calls to our newly enrolled members to make first point contact, complete health screener and answer any member questions. We are looking for candidates with outbound call center experience, excellence customer services, and ability to toggle back and forth between multiple screens and databases.

Home office with internet connectivity of high speed required.

Monday - Friday 8 AM to 5 PM EST (No weekends or Holidays)

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

• Serves as a community based member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing their healthcare needs.

• Collaborates with and supports the Healthcare Services team by providing non-clinical paraprofessional duties in the field, to include meeting with members in their homes, nursing homes, shelters, or doctor's offices, etc.

• Empowers members by helping them navigate and maximize their health plan benefits.

• Assistance may include: scheduling appointments with providers; arranging transportation for healthcare visits; getting prescriptions filled; and following up with members on missed appointments.

• Assists members in accessing social services such as community-based resources for housing, food, employment, etc.

• Provides outreach to locate and/or provide support for disconnected members with special needs.

• Conducts research with available data to locate members Molina Healthcare has been unable to contact (e.g., reviewing internal databases, contacting member providers or caregivers, or travel to last known address or community resource locations such as homeless shelters, etc.)

• Participates in ongoing or project-based activities that may require extensive member outreach (telephonically and/or face-to-face).

• Guides members to maintain Medicaid eligibility and with other financial resources as appropriate.

• 50-80% local travel may be required. Reliable transportation required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

HS Diploma/GED

REQUIRED EXPERIENCE:

- Minimum 1 year experience working with underserved or special needs populations, with varied health, economic and educational circumstances.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

- For Ohio, Florida, and California only -- Active and unrestricted Community Health Worker (CHW) Certification.

PREFERRED EDUCATION:

Associate's Degree in a health care related field (e.g., nutrition, counseling, social work).

PREFERRED EXPERIENCE:

- Bilingual based on community need.

- Familiarity with healthcare systems a plus.

- Knowledge of community-specific culture.

- Experience with or knowledge of health care basics, community resources, social services, and/or health education.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

- Current Community Health Worker (CHW) Certification preferred (for states other than Ohio, Florida and California, where it is required).

- Active and unrestricted Medical Assistant Certification

STATE SPECIFIC REQUIREMENTS: OHIO

- MHO Care Guide serves as a single point of contact for care coordination when there is no CCE, OhioRISE Plan, and/or CME involvement and short term care coordination needs are identified MHO Care Guide Plus serves as a single point of contact at Molina for care coordination when there is CCE, OhioRISE Plan, and/or CME involvement and short term care coordination needs are identified.

- Assures completion of a health risk assessment, assisting members to remediate immediate and acute gaps in care and access. Assist members with filing grievances and appeals.

- Connects members to CCEs, the OhioRISE Plan,or Molina Care Management if the members needs indicate a higher level of coordination. Provide information to members related to Molina requirements , services and benefits .

- Knowledge of internal MCO processes and procedures related to Care Guide responsibilities required

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: $14.76 - $31.97 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

The Community Connector will be working 100% remote in an outbound call environment (Must reside in the state of VA). Our Community Connectors will be working with our VA Medicaid newly enrolled members referred to us by Department Social Services. This individual will be making outbound calls to our newly enrolled members to make first point contact, complete health screener and answer any member questions. We are looking for candidates with outbound call center experience, excellence customer services, and ability to toggle back and forth between multiple screens and databases.

Home office with internet connectivity of high speed required.

Monday - Friday 8 AM to 5 PM EST (No weekends or Holidays)

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

• Serves as a community based member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing their healthcare needs.

• Collaborates with and supports the Healthcare Services team by providing non-clinical paraprofessional duties in the field, to include meeting with members in their homes, nursing homes, shelters, or doctor's offices, etc.

• Empowers members by helping them navigate and maximize their health plan benefits.

• Assistance may include: scheduling appointments with providers; arranging transportation for healthcare visits; getting prescriptions filled; and following up with members on missed appointments.

• Assists members in accessing social services such as community-based resources for housing, food, employment, etc.

• Provides outreach to locate and/or provide support for disconnected members with special needs.

• Conducts research with available data to locate members Molina Healthcare has been unable to contact (e.g., reviewing internal databases, contacting member providers or caregivers, or travel to last known address or community resource locations such as homeless shelters, etc.)

• Participates in ongoing or project-based activities that may require extensive member outreach (telephonically and/or face-to-face).

• Guides members to maintain Medicaid eligibility and with other financial resources as appropriate.

• 50-80% local travel may be required. Reliable transportation required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

HS Diploma/GED

REQUIRED EXPERIENCE:

- Minimum 1 year experience working with underserved or special needs populations, with varied health, economic and educational circumstances.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

- For Ohio, Florida, and California only -- Active and unrestricted Community Health Worker (CHW) Certification.

PREFERRED EDUCATION:

Associate's Degree in a health care related field (e.g., nutrition, counseling, social work).

PREFERRED EXPERIENCE:

- Bilingual based on community need.

- Familiarity with healthcare systems a plus.

- Knowledge of community-specific culture.

- Experience with or knowledge of health care basics, community resources, social services, and/or health education.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

- Current Community Health Worker (CHW) Certification preferred (for states other than Ohio, Florida and California, where it is required).

- Active and unrestricted Medical Assistant Certification

STATE SPECIFIC REQUIREMENTS: OHIO

- MHO Care Guide serves as a single point of contact for care coordination when there is no CCE, OhioRISE Plan, and/or CME involvement and short term care coordination needs are identified MHO Care Guide Plus serves as a single point of contact at Molina for care coordination when there is CCE, OhioRISE Plan, and/or CME involvement and short term care coordination needs are identified.

- Assures completion of a health risk assessment, assisting members to remediate immediate and acute gaps in care and access. Assist members with filing grievances and appeals.

- Connects members to CCEs, the OhioRISE Plan,or Molina Care Management if the members needs indicate a higher level of coordination. Provide information to members related to Molina requirements , services and benefits .

- Knowledge of internal MCO processes and procedures related to Care Guide responsibilities required

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: $14.76 - $31.97 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

*This hybrid role will work approximately 1-3 days in the office located in Hidalgo County, TX**

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

• Schedules member visits with team members as needed.

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

• Coordinates required services in accordance with member benefit plan.

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

• Processes member and provider correspondence.

JOB QUALIFICATIONS

Required Education

HS Diploma or GED

Required Experience

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

Preferred Education

Associate degree

Preferred Experience

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

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

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

Pay Range: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Plans, organizes, staffs, and coordinates the Provider Contracts activities for the state health plan. Works with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider contracts and contracting strategies.

Job Duties

Manages the Plan's Provider Contracting functions and team members. Responsible for leading the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Contracting functions. This role primarily leads negotiations of contracts with the Complex Provider Community that result in high quality, cost effective and marketable providers. Contract/Re-contracting with large scale entities involving custom reimbursement. Executes standardized Alternative Payment Method or Value Based Payment (VBP) contracts. Lead initiatives and activities issue escalations, network adequacy, and Joint Operating Committees.

- Manages and reports network adequacy for Medicare, Marketplace, and Medicaid services.

- In conjunction with direct management and senior leadership, oversees development of provider contracting strategies including VBP. This includes identifying those specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of members and patients in addition to identifying VBP provider targets to meet Molina goals.

- Leads the achievement of annual savings through recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region.

- Leads preparation and negotiations of provider contracts and oversee negotiation of contracts, including VBP, in concert with established company guidelines with physicians, hospitals, and other health care providers.

- Utilizes standardized contract templates and VBP/Pay for Performance strategies.

- Develops and maintains Reimbursement Tolerance Parameters (across multiple specialties/ geographies). Oversees the development of new reimbursement models in concert with direct management and senior leadership/management.

- Communicates new strategies to corporate provider network leadership for input.

- Utilize standardized system(s) to track contract negotiation activity on an ongoing basis throughout the year.

- Participates on the management team and other committees addressing the strategic goals of the department and organization.

- Oversees the maintenance of all Provider Contract templates including VBP program templates. Works with Legal and Corporate Network Management as needed to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.

- Manages the contracting relationships with area agencies and community partners to support and advance Plan initiatives.

- Develops and implements contracting strategies to comply with state, federal, NCQA, HEDIS initiatives and regulations.

- Manages and provides coaching to Network Contracting Staff.

- Manages and evaluates team member performance; provides coaching, consultation, employee development, and recognition; ensures ongoing, appropriate staff training; holds regular team meetings to drive good communication and collaboration; and has responsibility for the selection, orientation and mentoring of new staff.

Job Qualifications

REQUIRED EDUCATION :

Bachelor's Degree in a related field (Business Administration, etc.) or equivalent experience.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

- 7+ years experience in Healthcare Administration, Managed Care, Provider Contracting and/or Provider Services, including 2+ years in a direct or matrix leadership position

- 5+ years experience in provider contract negotiations in a managed healthcare setting including in negotiating different provider contract types and VBP models, i.e. physician, group and hospital contracting, etc.

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

- Min. 2 years experience managing/supervising employees.

PREFERRED EDUCATION :

Master's Degree in a related field or an equivalent combination of education and experience

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

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

Pay Range: $87,568.7 - $189,732.18 / 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

*Candidate must live in Kentucky for this work from home opportunity

JOB DESCRIPTION

Job Summary

Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.

Job Duties

- Provide service support to members and/or providers using one or more contact center communication channels and across multiple states and/or products. To include, but not limited to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business.

- Conduct varies surveys related to health assessments and member/provider satisfaction.

- Accurately document pertinent details related to Member or Provider inquiries.

- Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.

- Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations.

- Aptitude to listen attentively, capture relevant information, and identify Member or Provider's inquiries and concerns.

- Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.

- Able to proactively engage and collaborate with varies Internal/ External departments.

- Personal responsibility and accountability by taking ownership of providing resolutions in real time or through timely follow up with the Member and/or Provider.

- Supports provider needs for basic inquiries and assistance involving member eligibility and covered benefits, Provider Portal, and status of submitted claims.

- Ability to effectively communicate in a professionally setting.

Job Qualifications

REQUIRED EDUCATION :

HS Diploma or equivalent combination of education and experience

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment

PREFERRED EDUCATION :

Associate's Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE :

• 1-3 years

• Preferred Systems Training:

• Microsoft Office

• Genesys

• Salesforce

• Pega

• QNXT

• CRM

• Verint

• Kronos

• Microsoft Teams

• Video Conferencing

• CVS Caremark

• Availity

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.

#PJCC2

Pay Range: $11.09 - $24.02 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

• Meet with consumers at various sites throughout the communities

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

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

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

• Assist clients with choosing a plan and primary care physician

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

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

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

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

• Outreach Projects

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

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

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

• Develop and strengthen relations to generate new opportunities

• Attend external meetings as required

• Attend community health fairs and events as required

• Occasional weekend or evening availability for special events.

JOB QUALIFICATIONS

Required Education

HS Diploma

Required Experience

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

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

• Ability to meet deadlines

• Excellent written and oral communication skills; strong presentation skills

• Basic computer skills including Microsoft Word and Excel

• Strong interpersonal skills

• A positive attitude with ability to adapt to change

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

• Knowledge of Managed Care insurance plans

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

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

Required License, Certification, Association

Successful completion of the NYSOH required training, certification and recertification

Preferred Education

AA/AS - Associates degree

Preferred Experience

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

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

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

Pay Range: $16.5 - $31.97 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

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

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

Job Duties

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

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

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

• Establish and document reasonable medical diagnoses

• Seek specialty consultation as appropriate

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

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

• Create and implements a medical plan of care

• Schedule patient appointments for in-person visits when appropriate

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

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

• Additionally, may perform face-to-face synchronous video communications based on business need, leadership direction, and state regulations

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

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

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

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

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

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

• Actively participate in regional meetings

• Prescribe medications and perform procedures as appropriate

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Master's degree in family health from accredited nursing program

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

• Current Basic Life Support for Healthcare Professional certification

• Current unrestricted driver's license

PREFERRED EDUCATION:

PREFERRED EXPERIENCE:

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

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

• Experience with underserved populations facing socioeconomic barriers to health care

• Fluency in a language in addition to English is plus

• Immunization and point of care testing skills

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

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

#PJHS

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

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

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

Job Duties

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

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

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

• Establish and document reasonable medical diagnoses

• Seek specialty consultation as appropriate

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

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

• Create and implements a medical plan of care

• Schedule patient appointments for in-person visits when appropriate

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

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

• Additionally, may perform face-to-face synchronous video communications based on business need, leadership direction, and state regulations

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

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

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

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

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

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

• Actively participate in regional meetings

• Prescribe medications and perform procedures as appropriate

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Master's degree in family health from accredited nursing program

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

• Current Basic Life Support for Healthcare Professional certification

• Current unrestricted driver's license

PREFERRED EDUCATION:

PREFERRED EXPERIENCE:

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

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

• Experience with underserved populations facing socioeconomic barriers to health care

• Fluency in a language in addition to English is plus

• Immunization and point of care testing skills

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

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

#PJHS

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes

• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff

• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment

• Builds positive relationships between providers and Molina by providing coding assistance when necessary

• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education

• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Contributes to team effort by accomplishing related results as needed

• Other duties as assigned

• 2 years previous coding experience

• Proficient in Microsoft Office Suite

• Ability to effectively interface with staff, clinicians, and management

• Excellent verbal and written communication skills

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

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers

• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model

• Background in supporting risk adjustment management activities and clinical informatics

• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder - (CRC)

• Certified Professional Payer - Payer (CPC-P)

• Certified Coding Specialist - Physician based (CCS-P)

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: $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

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes

• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff

• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment

• Builds positive relationships between providers and Molina by providing coding assistance when necessary

• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education

• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Contributes to team effort by accomplishing related results as needed

• Other duties as assigned

• 2 years previous coding experience

• Proficient in Microsoft Office Suite

• Ability to effectively interface with staff, clinicians, and management

• Excellent verbal and written communication skills

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

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers

• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model

• Background in supporting risk adjustment management activities and clinical informatics

• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder - (CRC)

• Certified Professional Payer - Payer (CPC-P)

• Certified Coding Specialist - Physician based (CCS-P)

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: $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

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes

• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff

• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment

• Builds positive relationships between providers and Molina by providing coding assistance when necessary

• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education

• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Contributes to team effort by accomplishing related results as needed

• Other duties as assigned

• 2 years previous coding experience

• Proficient in Microsoft Office Suite

• Ability to effectively interface with staff, clinicians, and management

• Excellent verbal and written communication skills

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

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers

• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model

• Background in supporting risk adjustment management activities and clinical informatics

• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder - (CRC)

• Certified Professional Payer - Payer (CPC-P)

• Certified Coding Specialist - Physician based (CCS-P)

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: $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

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes

• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff

• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment

• Builds positive relationships between providers and Molina by providing coding assistance when necessary

• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education

• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Contributes to team effort by accomplishing related results as needed

• Other duties as assigned

• 2 years previous coding experience

• Proficient in Microsoft Office Suite

• Ability to effectively interface with staff, clinicians, and management

• Excellent verbal and written communication skills

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

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers

• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model

• Background in supporting risk adjustment management activities and clinical informatics

• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder - (CRC)

• Certified Professional Payer - Payer (CPC-P)

• Certified Coding Specialist - Physician based (CCS-P)

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: $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

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes

• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff

• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment

• Builds positive relationships between providers and Molina by providing coding assistance when necessary

• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education

• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Contributes to team effort by accomplishing related results as needed

• Other duties as assigned

• 2 years previous coding experience

• Proficient in Microsoft Office Suite

• Ability to effectively interface with staff, clinicians, and management

• Excellent verbal and written communication skills

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

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers

• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model

• Background in supporting risk adjustment management activities and clinical informatics

• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder - (CRC)

• Certified Professional Payer - Payer (CPC-P)

• Certified Coding Specialist - Physician based (CCS-P)

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: $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

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes

• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff

• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment

• Builds positive relationships between providers and Molina by providing coding assistance when necessary

• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education

• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Contributes to team effort by accomplishing related results as needed

• Other duties as assigned

• 2 years previous coding experience

• Proficient in Microsoft Office Suite

• Ability to effectively interface with staff, clinicians, and management

• Excellent verbal and written communication skills

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

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers

• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model

• Background in supporting risk adjustment management activities and clinical informatics

• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder - (CRC)

• Certified Professional Payer - Payer (CPC-P)

• Certified Coding Specialist - Physician based (CCS-P)

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: $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

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes

• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff

• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment

• Builds positive relationships between providers and Molina by providing coding assistance when necessary

• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education

• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Contributes to team effort by accomplishing related results as needed

• Other duties as assigned

• 2 years previous coding experience

• Proficient in Microsoft Office Suite

• Ability to effectively interface with staff, clinicians, and management

• Excellent verbal and written communication skills

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

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers

• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model

• Background in supporting risk adjustment management activities and clinical informatics

• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder - (CRC)

• Certified Professional Payer - Payer (CPC-P)

• Certified Coding Specialist - Physician based (CCS-P)

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: $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

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes

• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff

• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment

• Builds positive relationships between providers and Molina by providing coding assistance when necessary

• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education

• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Contributes to team effort by accomplishing related results as needed

• Other duties as assigned

• 2 years previous coding experience

• Proficient in Microsoft Office Suite

• Ability to effectively interface with staff, clinicians, and management

• Excellent verbal and written communication skills

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

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers

• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model

• Background in supporting risk adjustment management activities and clinical informatics

• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder - (CRC)

• Certified Professional Payer - Payer (CPC-P)

• Certified Coding Specialist - Physician based (CCS-P)

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: $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

This job position will work CST or EST business hours

Job Summary

Molina's HEDIS/Quality Improvement Sr. Medical Records Collector is a team member with several years experience in working collaboratively with outreaching to providers in order to pursue medical records via phone call, fax, mail, electronic medical record system retrieval and direct onsite pick up, for the HEDIS projects. These team members help mentor other team members and take the lead on process and project improvement. These team members act as the subject matter experts in the area of medical record collection/pursuit.

Job Duties

• Under the direction of the national and/or regional lead, the Medical Records Collector supports the annual HEDIS audit and other HEDIS like audits, by organizing provider outreach, pursuit, collection and upload of provider medical records into the internal database.

• Subject matter expert in the area of project management/coordination of the identification, pursuit and collection of medical records and other data in collaboration with other HEDIS staff.

• Assists the Manager and Supervisor(s) and/or performs the coordination and preparation of the HEDIS medical record collection process that includes the pursuit via phone call, fax, mail, electronic medical record system retrieval and direct onsite pick up.

• Participates and prepared feedback for the vendor meetings in relation to the medical record collection process.

• Subject matter expert in the area of collecting medical records and reports from provider offices, loads data into the HEDIS application.

• Assists the manager/lead and quality improvement staff with physician and member interventions and incentive efforts as needed through review of medical records documentation.

Job Qualifications

REQUIRED EDUCATION:

High School Diploma or equivalent

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 3+ seasons/years medical record collection experience.

• 3+ years managed care experience.

• Basic knowledge of HEDIS and NCQA

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

PREFERRED EXPERIENCE:

3 years HEDIS data collection experience.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Certified Medical Record Technician

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: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare