Company Detail

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

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

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

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

This role is not a IT-focused Security Operations (SOC) threat monitoring, incident identification and investigation activity. This role will support the overall cyber response program, which is heavily focused on business response and fully integrated into the enterprise crisis management program. The Cyber Response Manager will be primarily responsible for day-to-day delivery of cyber response /crisis management program activities, including providing guidance and consultation to employees across the enterprise to ensure compliance. Support response to situations impacting Molina's data, people, property, or facilities. Assist in special projects and risk mitigation programs to strengthen organizational resiliency. Develop, communicate, and execute cyber crisis management plans and playbooks. Coordinate and lead cyber crisis management tabletops, process and procedure testing and corrective actions. Lead cross-functional crisis and incident management teams during an enterprise-wide cyber crisis. Conduct incident after action reviews to identify strengths, improvement opportunities and track corrective actions. Support the Cyber Crisis Enterprise strategy to ensure cyber incidents are well organized, executed and resolved.

Partners closely with IT Security, Business Continuity, Disaster Response, and the Protection Services Operations Center to ensure appropriate engagement and escalation protocols to support business and technology incidents. Coordinate with MHI, Health Plan, and Health Plan Services staff to consult on the design, development and deployment of scalable solutions, tools and capabilities that align to the company's goals and effectively address business objectives and requirements. Serves as the alternate enterprise crisis management interfacing with Molina's senior executive team and leading the organization through man-made or natural disasters.

Job Duties

• Drive commitment, support, ownership, accountability and results for the enterprise Cyber Response, Incident Response and Crisis Management activities

• Assist with cyber response program and process documentation including policies, procedures, frameworks, templates, and work instructions in support of the program and meeting regulatory requirements.

• Conduct research and analysis to support programs and projects

• Develop and conduct employee training to create awareness for areas of responsibility

• Support enterprise threat and cyber crisis response activities including:

• Incident notifications and situational updates

• Employee emergency notifications

• Threat monitoring and analysis. Notification of threat to appropriate stakeholders

• Cyber Incident Response team meeting coordination and minutes

• Support state-specific incident response leadership

• Facilitate support for impacted business operations

• Prepare comprehensive, timely, and detailed after-action reports

• Analyze trends across incidents and exercises to recommend improvements that may not be apparent from looking at each incident or exercise in isolation.

• Assist with documenting the standards, SOPs, Incident Response playbooks, escalation protocols, etc. to facilitate response capabilities

• Validate, test, and identify gaps in strategies and communicating results to leadership

• Reviews and provides input on select enterprise systems, tools, and services to ensure effective planning, testing and response capabilities including out of band options

• Periodically test and ensure readiness of continuity tools, including tools for out-of-band notification or incident communications.

• Establish and maintain communication with enterprise crisis management, incident response team, and state-specific response team members

• Coordinate with Cyber Response Teams, CISO, Legal, Privacy, and Protection Services Operations Center to respond to and support cyber crisis situations

• Develop, enhance, and improve enterprise crisis management, cyber response while supporting incident plans and state-specific response plans. Ensure annual plan compliance requirements are achieved

• Implement processes, procedures and systems that will help ensure that the company's continuity capabilities remain in compliance with all laws, regulations, and best practices.

• Assist in the evaluation, design and deployment of integrated systems and technology that support response, intelligence, service delivery and organizational strategy.

• Maintain roster of cyber crisis management and incident response team members

• Conduct annual training of all crisis management and incident response plans or as changes to each location team. Prepare comprehensive, timely, and detailed test reports

• Maintain lessons learned and remediation tracker. Ensure items requiring remediation are resolved within a timely manner

• Assist in development of metrics and measurements supporting program evolution, validation, and business awareness

• Other duties as assigned by leadership

Job Qualifications

Required Education:

Bachelor's degree in an applicable field

Required Experience:

• Minimum of 7 years operational experience across crisis management, resilience and cybersecurity incident response disciplines

• 5 years of corporate business experience in Cyber Response, Incident Response, Crisis management, Disaster Recovery, and Resilience.

• Experience conducting risk assessments, business process or control auditing.

• Strong documentation skills - detailed tracking, executive briefings, and reports, etc.

• Practical understanding of technical/security concepts such as network architecture design, logical access controls, vulnerability management, encryption, and cloud computing.

• Problem solving and analytical abilities including the ability to critically evaluate information gathered from multiple sources, reconcile conflicts, decompose high-level information into details and apply sound business knowledge.

• Strong organizational, interpersonal, analytical, verbal, and written communication skills are essential.

• Ability to build and maintain customer relationships; strong team player, able to meet deadlines and adjust to changing priorities.

• Demonstrated focus on process development and implementation that spans organizational boundaries.

• Self-starter with ability to work independently and to manage multiple tasks/projects in a disciplined and organized fashion while maintaining attention to detail.

• Ability to work collaboratively with team members, some of which may be geographically distributed.

• Power BI experience a plus

• BC in the Cloud, Everbridge and Envoy platform/tool experience

• Familiar with Kroll, CrowdStrike, or other forensics/cyber investigation providers

Required Licensure or Certification:

Required Knowledge, Skills, and Abilities:

• A strong grasp and hands-on experience in cyber incident response, disaster response and crisis management

• Understand cyber response and recovery stages and the fundamentals of incident response planning, testing, exercises

• Situational awareness and responding to incidents that pose a threat to company, property, data, or people

• Creation of metrics, reporting and analysis

• Cyber trends - ransomware, malware, phishing, insider threat, etc.

• ChatGPT and CoPilot-using AI for research

• Familiarity with industry best practices and standards for cyber and crisis events

• Project Management

• Experience with industry standard tools and concepts. BC in the Cloud, Everbridge and Envoy platform/tool experience preferred

Preferred Qualifications:

• BCI or DRII certification(s) a plus; Cyber certifications preferred CISA or CISSP

• Master's degree preferred.

Travel Requirements:

Air Travel: 5-10%

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

This role is not a IT-focused Security Operations (SOC) threat monitoring, incident identification and investigation activity. This role will support the overall cyber response program, which is heavily focused on business response and fully integrated into the enterprise crisis management program. The Cyber Response Manager will be primarily responsible for day-to-day delivery of cyber response /crisis management program activities, including providing guidance and consultation to employees across the enterprise to ensure compliance. Support response to situations impacting Molina's data, people, property, or facilities. Assist in special projects and risk mitigation programs to strengthen organizational resiliency. Develop, communicate, and execute cyber crisis management plans and playbooks. Coordinate and lead cyber crisis management tabletops, process and procedure testing and corrective actions. Lead cross-functional crisis and incident management teams during an enterprise-wide cyber crisis. Conduct incident after action reviews to identify strengths, improvement opportunities and track corrective actions. Support the Cyber Crisis Enterprise strategy to ensure cyber incidents are well organized, executed and resolved.

Partners closely with IT Security, Business Continuity, Disaster Response, and the Protection Services Operations Center to ensure appropriate engagement and escalation protocols to support business and technology incidents. Coordinate with MHI, Health Plan, and Health Plan Services staff to consult on the design, development and deployment of scalable solutions, tools and capabilities that align to the company's goals and effectively address business objectives and requirements. Serves as the alternate enterprise crisis management interfacing with Molina's senior executive team and leading the organization through man-made or natural disasters.

Job Duties

• Drive commitment, support, ownership, accountability and results for the enterprise Cyber Response, Incident Response and Crisis Management activities

• Assist with cyber response program and process documentation including policies, procedures, frameworks, templates, and work instructions in support of the program and meeting regulatory requirements.

• Conduct research and analysis to support programs and projects

• Develop and conduct employee training to create awareness for areas of responsibility

• Support enterprise threat and cyber crisis response activities including:

• Incident notifications and situational updates

• Employee emergency notifications

• Threat monitoring and analysis. Notification of threat to appropriate stakeholders

• Cyber Incident Response team meeting coordination and minutes

• Support state-specific incident response leadership

• Facilitate support for impacted business operations

• Prepare comprehensive, timely, and detailed after-action reports

• Analyze trends across incidents and exercises to recommend improvements that may not be apparent from looking at each incident or exercise in isolation.

• Assist with documenting the standards, SOPs, Incident Response playbooks, escalation protocols, etc. to facilitate response capabilities

• Validate, test, and identify gaps in strategies and communicating results to leadership

• Reviews and provides input on select enterprise systems, tools, and services to ensure effective planning, testing and response capabilities including out of band options

• Periodically test and ensure readiness of continuity tools, including tools for out-of-band notification or incident communications.

• Establish and maintain communication with enterprise crisis management, incident response team, and state-specific response team members

• Coordinate with Cyber Response Teams, CISO, Legal, Privacy, and Protection Services Operations Center to respond to and support cyber crisis situations

• Develop, enhance, and improve enterprise crisis management, cyber response while supporting incident plans and state-specific response plans. Ensure annual plan compliance requirements are achieved

• Implement processes, procedures and systems that will help ensure that the company's continuity capabilities remain in compliance with all laws, regulations, and best practices.

• Assist in the evaluation, design and deployment of integrated systems and technology that support response, intelligence, service delivery and organizational strategy.

• Maintain roster of cyber crisis management and incident response team members

• Conduct annual training of all crisis management and incident response plans or as changes to each location team. Prepare comprehensive, timely, and detailed test reports

• Maintain lessons learned and remediation tracker. Ensure items requiring remediation are resolved within a timely manner

• Assist in development of metrics and measurements supporting program evolution, validation, and business awareness

• Other duties as assigned by leadership

Job Qualifications

Required Education:

Bachelor's degree in an applicable field

Required Experience:

• Minimum of 7 years operational experience across crisis management, resilience and cybersecurity incident response disciplines

• 5 years of corporate business experience in Cyber Response, Incident Response, Crisis management, Disaster Recovery, and Resilience.

• Experience conducting risk assessments, business process or control auditing.

• Strong documentation skills - detailed tracking, executive briefings, and reports, etc.

• Practical understanding of technical/security concepts such as network architecture design, logical access controls, vulnerability management, encryption, and cloud computing.

• Problem solving and analytical abilities including the ability to critically evaluate information gathered from multiple sources, reconcile conflicts, decompose high-level information into details and apply sound business knowledge.

• Strong organizational, interpersonal, analytical, verbal, and written communication skills are essential.

• Ability to build and maintain customer relationships; strong team player, able to meet deadlines and adjust to changing priorities.

• Demonstrated focus on process development and implementation that spans organizational boundaries.

• Self-starter with ability to work independently and to manage multiple tasks/projects in a disciplined and organized fashion while maintaining attention to detail.

• Ability to work collaboratively with team members, some of which may be geographically distributed.

• Power BI experience a plus

• BC in the Cloud, Everbridge and Envoy platform/tool experience

• Familiar with Kroll, CrowdStrike, or other forensics/cyber investigation providers

Required Licensure or Certification:

Required Knowledge, Skills, and Abilities:

• A strong grasp and hands-on experience in cyber incident response, disaster response and crisis management

• Understand cyber response and recovery stages and the fundamentals of incident response planning, testing, exercises

• Situational awareness and responding to incidents that pose a threat to company, property, data, or people

• Creation of metrics, reporting and analysis

• Cyber trends - ransomware, malware, phishing, insider threat, etc.

• ChatGPT and CoPilot-using AI for research

• Familiarity with industry best practices and standards for cyber and crisis events

• Project Management

• Experience with industry standard tools and concepts. BC in the Cloud, Everbridge and Envoy platform/tool experience preferred

Preferred Qualifications:

• BCI or DRII certification(s) a plus; Cyber certifications preferred CISA or CISSP

• Master's degree preferred.

Travel Requirements:

Air Travel: 5-10%

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

This role is not a IT-focused Security Operations (SOC) threat monitoring, incident identification and investigation activity. This role will support the overall cyber response program, which is heavily focused on business response and fully integrated into the enterprise crisis management program. The Cyber Response Manager will be primarily responsible for day-to-day delivery of cyber response /crisis management program activities, including providing guidance and consultation to employees across the enterprise to ensure compliance. Support response to situations impacting Molina's data, people, property, or facilities. Assist in special projects and risk mitigation programs to strengthen organizational resiliency. Develop, communicate, and execute cyber crisis management plans and playbooks. Coordinate and lead cyber crisis management tabletops, process and procedure testing and corrective actions. Lead cross-functional crisis and incident management teams during an enterprise-wide cyber crisis. Conduct incident after action reviews to identify strengths, improvement opportunities and track corrective actions. Support the Cyber Crisis Enterprise strategy to ensure cyber incidents are well organized, executed and resolved.

Partners closely with IT Security, Business Continuity, Disaster Response, and the Protection Services Operations Center to ensure appropriate engagement and escalation protocols to support business and technology incidents. Coordinate with MHI, Health Plan, and Health Plan Services staff to consult on the design, development and deployment of scalable solutions, tools and capabilities that align to the company's goals and effectively address business objectives and requirements. Serves as the alternate enterprise crisis management interfacing with Molina's senior executive team and leading the organization through man-made or natural disasters.

Job Duties

• Drive commitment, support, ownership, accountability and results for the enterprise Cyber Response, Incident Response and Crisis Management activities

• Assist with cyber response program and process documentation including policies, procedures, frameworks, templates, and work instructions in support of the program and meeting regulatory requirements.

• Conduct research and analysis to support programs and projects

• Develop and conduct employee training to create awareness for areas of responsibility

• Support enterprise threat and cyber crisis response activities including:

• Incident notifications and situational updates

• Employee emergency notifications

• Threat monitoring and analysis. Notification of threat to appropriate stakeholders

• Cyber Incident Response team meeting coordination and minutes

• Support state-specific incident response leadership

• Facilitate support for impacted business operations

• Prepare comprehensive, timely, and detailed after-action reports

• Analyze trends across incidents and exercises to recommend improvements that may not be apparent from looking at each incident or exercise in isolation.

• Assist with documenting the standards, SOPs, Incident Response playbooks, escalation protocols, etc. to facilitate response capabilities

• Validate, test, and identify gaps in strategies and communicating results to leadership

• Reviews and provides input on select enterprise systems, tools, and services to ensure effective planning, testing and response capabilities including out of band options

• Periodically test and ensure readiness of continuity tools, including tools for out-of-band notification or incident communications.

• Establish and maintain communication with enterprise crisis management, incident response team, and state-specific response team members

• Coordinate with Cyber Response Teams, CISO, Legal, Privacy, and Protection Services Operations Center to respond to and support cyber crisis situations

• Develop, enhance, and improve enterprise crisis management, cyber response while supporting incident plans and state-specific response plans. Ensure annual plan compliance requirements are achieved

• Implement processes, procedures and systems that will help ensure that the company's continuity capabilities remain in compliance with all laws, regulations, and best practices.

• Assist in the evaluation, design and deployment of integrated systems and technology that support response, intelligence, service delivery and organizational strategy.

• Maintain roster of cyber crisis management and incident response team members

• Conduct annual training of all crisis management and incident response plans or as changes to each location team. Prepare comprehensive, timely, and detailed test reports

• Maintain lessons learned and remediation tracker. Ensure items requiring remediation are resolved within a timely manner

• Assist in development of metrics and measurements supporting program evolution, validation, and business awareness

• Other duties as assigned by leadership

Job Qualifications

Required Education:

Bachelor's degree in an applicable field

Required Experience:

• Minimum of 7 years operational experience across crisis management, resilience and cybersecurity incident response disciplines

• 5 years of corporate business experience in Cyber Response, Incident Response, Crisis management, Disaster Recovery, and Resilience.

• Experience conducting risk assessments, business process or control auditing.

• Strong documentation skills - detailed tracking, executive briefings, and reports, etc.

• Practical understanding of technical/security concepts such as network architecture design, logical access controls, vulnerability management, encryption, and cloud computing.

• Problem solving and analytical abilities including the ability to critically evaluate information gathered from multiple sources, reconcile conflicts, decompose high-level information into details and apply sound business knowledge.

• Strong organizational, interpersonal, analytical, verbal, and written communication skills are essential.

• Ability to build and maintain customer relationships; strong team player, able to meet deadlines and adjust to changing priorities.

• Demonstrated focus on process development and implementation that spans organizational boundaries.

• Self-starter with ability to work independently and to manage multiple tasks/projects in a disciplined and organized fashion while maintaining attention to detail.

• Ability to work collaboratively with team members, some of which may be geographically distributed.

• Power BI experience a plus

• BC in the Cloud, Everbridge and Envoy platform/tool experience

• Familiar with Kroll, CrowdStrike, or other forensics/cyber investigation providers

Required Licensure or Certification:

Required Knowledge, Skills, and Abilities:

• A strong grasp and hands-on experience in cyber incident response, disaster response and crisis management

• Understand cyber response and recovery stages and the fundamentals of incident response planning, testing, exercises

• Situational awareness and responding to incidents that pose a threat to company, property, data, or people

• Creation of metrics, reporting and analysis

• Cyber trends - ransomware, malware, phishing, insider threat, etc.

• ChatGPT and CoPilot-using AI for research

• Familiarity with industry best practices and standards for cyber and crisis events

• Project Management

• Experience with industry standard tools and concepts. BC in the Cloud, Everbridge and Envoy platform/tool experience preferred

Preferred Qualifications:

• BCI or DRII certification(s) a plus; Cyber certifications preferred CISA or CISSP

• Master's degree preferred.

Travel Requirements:

Air Travel: 5-10%

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

For this position we are seeking a (RN) Registered Nurse who lives in VIRGINIA and must be licensed for the state of VIRGINIA.

Case Manager will work in remote and field setting supporting our Medicaid Population with. Case Manager will be required to physically go to member's homes to complete Face to Face assessment. You will participate in interdisciplinary care team meetings for our members and ensure they have care plans based on their concerns/health needs. Members have required assessments every six months and can also require -trigger assessments- if they have hospitalizations. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important.

TRAVEL (50% or more) in the field to do member visits in the surrounding areas will be required. We are looking for a candidate who will work remotely primarily in the Eastern Shore VA - Mileage will be reimbursed.

Home office with internet connectivity of high speed required.

Schedule: Monday thru Friday 8:00AM to 5:00PM. - No weekends are Holidays. (On Call One week a year)

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

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

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

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

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

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

• Required License, Certification, Association

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

• If field work is required, Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

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

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

This role is not a IT-focused Security Operations (SOC) threat monitoring, incident identification and investigation activity. This role will support the overall cyber response program, which is heavily focused on business response and fully integrated into the enterprise crisis management program. The Cyber Response Manager will be primarily responsible for day-to-day delivery of cyber response /crisis management program activities, including providing guidance and consultation to employees across the enterprise to ensure compliance. Support response to situations impacting Molina's data, people, property, or facilities. Assist in special projects and risk mitigation programs to strengthen organizational resiliency. Develop, communicate, and execute cyber crisis management plans and playbooks. Coordinate and lead cyber crisis management tabletops, process and procedure testing and corrective actions. Lead cross-functional crisis and incident management teams during an enterprise-wide cyber crisis. Conduct incident after action reviews to identify strengths, improvement opportunities and track corrective actions. Support the Cyber Crisis Enterprise strategy to ensure cyber incidents are well organized, executed and resolved.

Partners closely with IT Security, Business Continuity, Disaster Response, and the Protection Services Operations Center to ensure appropriate engagement and escalation protocols to support business and technology incidents. Coordinate with MHI, Health Plan, and Health Plan Services staff to consult on the design, development and deployment of scalable solutions, tools and capabilities that align to the company's goals and effectively address business objectives and requirements. Serves as the alternate enterprise crisis management interfacing with Molina's senior executive team and leading the organization through man-made or natural disasters.

Job Duties

• Drive commitment, support, ownership, accountability and results for the enterprise Cyber Response, Incident Response and Crisis Management activities

• Assist with cyber response program and process documentation including policies, procedures, frameworks, templates, and work instructions in support of the program and meeting regulatory requirements.

• Conduct research and analysis to support programs and projects

• Develop and conduct employee training to create awareness for areas of responsibility

• Support enterprise threat and cyber crisis response activities including:

• Incident notifications and situational updates

• Employee emergency notifications

• Threat monitoring and analysis. Notification of threat to appropriate stakeholders

• Cyber Incident Response team meeting coordination and minutes

• Support state-specific incident response leadership

• Facilitate support for impacted business operations

• Prepare comprehensive, timely, and detailed after-action reports

• Analyze trends across incidents and exercises to recommend improvements that may not be apparent from looking at each incident or exercise in isolation.

• Assist with documenting the standards, SOPs, Incident Response playbooks, escalation protocols, etc. to facilitate response capabilities

• Validate, test, and identify gaps in strategies and communicating results to leadership

• Reviews and provides input on select enterprise systems, tools, and services to ensure effective planning, testing and response capabilities including out of band options

• Periodically test and ensure readiness of continuity tools, including tools for out-of-band notification or incident communications.

• Establish and maintain communication with enterprise crisis management, incident response team, and state-specific response team members

• Coordinate with Cyber Response Teams, CISO, Legal, Privacy, and Protection Services Operations Center to respond to and support cyber crisis situations

• Develop, enhance, and improve enterprise crisis management, cyber response while supporting incident plans and state-specific response plans. Ensure annual plan compliance requirements are achieved

• Implement processes, procedures and systems that will help ensure that the company's continuity capabilities remain in compliance with all laws, regulations, and best practices.

• Assist in the evaluation, design and deployment of integrated systems and technology that support response, intelligence, service delivery and organizational strategy.

• Maintain roster of cyber crisis management and incident response team members

• Conduct annual training of all crisis management and incident response plans or as changes to each location team. Prepare comprehensive, timely, and detailed test reports

• Maintain lessons learned and remediation tracker. Ensure items requiring remediation are resolved within a timely manner

• Assist in development of metrics and measurements supporting program evolution, validation, and business awareness

• Other duties as assigned by leadership

Job Qualifications

Required Education:

Bachelor's degree in an applicable field

Required Experience:

• Minimum of 7 years operational experience across crisis management, resilience and cybersecurity incident response disciplines

• 5 years of corporate business experience in Cyber Response, Incident Response, Crisis management, Disaster Recovery, and Resilience.

• Experience conducting risk assessments, business process or control auditing.

• Strong documentation skills - detailed tracking, executive briefings, and reports, etc.

• Practical understanding of technical/security concepts such as network architecture design, logical access controls, vulnerability management, encryption, and cloud computing.

• Problem solving and analytical abilities including the ability to critically evaluate information gathered from multiple sources, reconcile conflicts, decompose high-level information into details and apply sound business knowledge.

• Strong organizational, interpersonal, analytical, verbal, and written communication skills are essential.

• Ability to build and maintain customer relationships; strong team player, able to meet deadlines and adjust to changing priorities.

• Demonstrated focus on process development and implementation that spans organizational boundaries.

• Self-starter with ability to work independently and to manage multiple tasks/projects in a disciplined and organized fashion while maintaining attention to detail.

• Ability to work collaboratively with team members, some of which may be geographically distributed.

• Power BI experience a plus

• BC in the Cloud, Everbridge and Envoy platform/tool experience

• Familiar with Kroll, CrowdStrike, or other forensics/cyber investigation providers

Required Licensure or Certification:

Required Knowledge, Skills, and Abilities:

• A strong grasp and hands-on experience in cyber incident response, disaster response and crisis management

• Understand cyber response and recovery stages and the fundamentals of incident response planning, testing, exercises

• Situational awareness and responding to incidents that pose a threat to company, property, data, or people

• Creation of metrics, reporting and analysis

• Cyber trends - ransomware, malware, phishing, insider threat, etc.

• ChatGPT and CoPilot-using AI for research

• Familiarity with industry best practices and standards for cyber and crisis events

• Project Management

• Experience with industry standard tools and concepts. BC in the Cloud, Everbridge and Envoy platform/tool experience preferred

Preferred Qualifications:

• BCI or DRII certification(s) a plus; Cyber certifications preferred CISA or CISSP

• Master's degree preferred.

Travel Requirements:

Air Travel: 5-10%

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

This role is not a IT-focused Security Operations (SOC) threat monitoring, incident identification and investigation activity. This role will support the overall cyber response program, which is heavily focused on business response and fully integrated into the enterprise crisis management program. The Cyber Response Manager will be primarily responsible for day-to-day delivery of cyber response /crisis management program activities, including providing guidance and consultation to employees across the enterprise to ensure compliance. Support response to situations impacting Molina's data, people, property, or facilities. Assist in special projects and risk mitigation programs to strengthen organizational resiliency. Develop, communicate, and execute cyber crisis management plans and playbooks. Coordinate and lead cyber crisis management tabletops, process and procedure testing and corrective actions. Lead cross-functional crisis and incident management teams during an enterprise-wide cyber crisis. Conduct incident after action reviews to identify strengths, improvement opportunities and track corrective actions. Support the Cyber Crisis Enterprise strategy to ensure cyber incidents are well organized, executed and resolved.

Partners closely with IT Security, Business Continuity, Disaster Response, and the Protection Services Operations Center to ensure appropriate engagement and escalation protocols to support business and technology incidents. Coordinate with MHI, Health Plan, and Health Plan Services staff to consult on the design, development and deployment of scalable solutions, tools and capabilities that align to the company's goals and effectively address business objectives and requirements. Serves as the alternate enterprise crisis management interfacing with Molina's senior executive team and leading the organization through man-made or natural disasters.

Job Duties

• Drive commitment, support, ownership, accountability and results for the enterprise Cyber Response, Incident Response and Crisis Management activities

• Assist with cyber response program and process documentation including policies, procedures, frameworks, templates, and work instructions in support of the program and meeting regulatory requirements.

• Conduct research and analysis to support programs and projects

• Develop and conduct employee training to create awareness for areas of responsibility

• Support enterprise threat and cyber crisis response activities including:

• Incident notifications and situational updates

• Employee emergency notifications

• Threat monitoring and analysis. Notification of threat to appropriate stakeholders

• Cyber Incident Response team meeting coordination and minutes

• Support state-specific incident response leadership

• Facilitate support for impacted business operations

• Prepare comprehensive, timely, and detailed after-action reports

• Analyze trends across incidents and exercises to recommend improvements that may not be apparent from looking at each incident or exercise in isolation.

• Assist with documenting the standards, SOPs, Incident Response playbooks, escalation protocols, etc. to facilitate response capabilities

• Validate, test, and identify gaps in strategies and communicating results to leadership

• Reviews and provides input on select enterprise systems, tools, and services to ensure effective planning, testing and response capabilities including out of band options

• Periodically test and ensure readiness of continuity tools, including tools for out-of-band notification or incident communications.

• Establish and maintain communication with enterprise crisis management, incident response team, and state-specific response team members

• Coordinate with Cyber Response Teams, CISO, Legal, Privacy, and Protection Services Operations Center to respond to and support cyber crisis situations

• Develop, enhance, and improve enterprise crisis management, cyber response while supporting incident plans and state-specific response plans. Ensure annual plan compliance requirements are achieved

• Implement processes, procedures and systems that will help ensure that the company's continuity capabilities remain in compliance with all laws, regulations, and best practices.

• Assist in the evaluation, design and deployment of integrated systems and technology that support response, intelligence, service delivery and organizational strategy.

• Maintain roster of cyber crisis management and incident response team members

• Conduct annual training of all crisis management and incident response plans or as changes to each location team. Prepare comprehensive, timely, and detailed test reports

• Maintain lessons learned and remediation tracker. Ensure items requiring remediation are resolved within a timely manner

• Assist in development of metrics and measurements supporting program evolution, validation, and business awareness

• Other duties as assigned by leadership

Job Qualifications

Required Education:

Bachelor's degree in an applicable field

Required Experience:

• Minimum of 7 years operational experience across crisis management, resilience and cybersecurity incident response disciplines

• 5 years of corporate business experience in Cyber Response, Incident Response, Crisis management, Disaster Recovery, and Resilience.

• Experience conducting risk assessments, business process or control auditing.

• Strong documentation skills - detailed tracking, executive briefings, and reports, etc.

• Practical understanding of technical/security concepts such as network architecture design, logical access controls, vulnerability management, encryption, and cloud computing.

• Problem solving and analytical abilities including the ability to critically evaluate information gathered from multiple sources, reconcile conflicts, decompose high-level information into details and apply sound business knowledge.

• Strong organizational, interpersonal, analytical, verbal, and written communication skills are essential.

• Ability to build and maintain customer relationships; strong team player, able to meet deadlines and adjust to changing priorities.

• Demonstrated focus on process development and implementation that spans organizational boundaries.

• Self-starter with ability to work independently and to manage multiple tasks/projects in a disciplined and organized fashion while maintaining attention to detail.

• Ability to work collaboratively with team members, some of which may be geographically distributed.

• Power BI experience a plus

• BC in the Cloud, Everbridge and Envoy platform/tool experience

• Familiar with Kroll, CrowdStrike, or other forensics/cyber investigation providers

Required Licensure or Certification:

Required Knowledge, Skills, and Abilities:

• A strong grasp and hands-on experience in cyber incident response, disaster response and crisis management

• Understand cyber response and recovery stages and the fundamentals of incident response planning, testing, exercises

• Situational awareness and responding to incidents that pose a threat to company, property, data, or people

• Creation of metrics, reporting and analysis

• Cyber trends - ransomware, malware, phishing, insider threat, etc.

• ChatGPT and CoPilot-using AI for research

• Familiarity with industry best practices and standards for cyber and crisis events

• Project Management

• Experience with industry standard tools and concepts. BC in the Cloud, Everbridge and Envoy platform/tool experience preferred

Preferred Qualifications:

• BCI or DRII certification(s) a plus; Cyber certifications preferred CISA or CISSP

• Master's degree preferred.

Travel Requirements:

Air Travel: 5-10%

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

This role is not a IT-focused Security Operations (SOC) threat monitoring, incident identification and investigation activity. This role will support the overall cyber response program, which is heavily focused on business response and fully integrated into the enterprise crisis management program. The Cyber Response Manager will be primarily responsible for day-to-day delivery of cyber response /crisis management program activities, including providing guidance and consultation to employees across the enterprise to ensure compliance. Support response to situations impacting Molina's data, people, property, or facilities. Assist in special projects and risk mitigation programs to strengthen organizational resiliency. Develop, communicate, and execute cyber crisis management plans and playbooks. Coordinate and lead cyber crisis management tabletops, process and procedure testing and corrective actions. Lead cross-functional crisis and incident management teams during an enterprise-wide cyber crisis. Conduct incident after action reviews to identify strengths, improvement opportunities and track corrective actions. Support the Cyber Crisis Enterprise strategy to ensure cyber incidents are well organized, executed and resolved.

Partners closely with IT Security, Business Continuity, Disaster Response, and the Protection Services Operations Center to ensure appropriate engagement and escalation protocols to support business and technology incidents. Coordinate with MHI, Health Plan, and Health Plan Services staff to consult on the design, development and deployment of scalable solutions, tools and capabilities that align to the company's goals and effectively address business objectives and requirements. Serves as the alternate enterprise crisis management interfacing with Molina's senior executive team and leading the organization through man-made or natural disasters.

Job Duties

• Drive commitment, support, ownership, accountability and results for the enterprise Cyber Response, Incident Response and Crisis Management activities

• Assist with cyber response program and process documentation including policies, procedures, frameworks, templates, and work instructions in support of the program and meeting regulatory requirements.

• Conduct research and analysis to support programs and projects

• Develop and conduct employee training to create awareness for areas of responsibility

• Support enterprise threat and cyber crisis response activities including:

• Incident notifications and situational updates

• Employee emergency notifications

• Threat monitoring and analysis. Notification of threat to appropriate stakeholders

• Cyber Incident Response team meeting coordination and minutes

• Support state-specific incident response leadership

• Facilitate support for impacted business operations

• Prepare comprehensive, timely, and detailed after-action reports

• Analyze trends across incidents and exercises to recommend improvements that may not be apparent from looking at each incident or exercise in isolation.

• Assist with documenting the standards, SOPs, Incident Response playbooks, escalation protocols, etc. to facilitate response capabilities

• Validate, test, and identify gaps in strategies and communicating results to leadership

• Reviews and provides input on select enterprise systems, tools, and services to ensure effective planning, testing and response capabilities including out of band options

• Periodically test and ensure readiness of continuity tools, including tools for out-of-band notification or incident communications.

• Establish and maintain communication with enterprise crisis management, incident response team, and state-specific response team members

• Coordinate with Cyber Response Teams, CISO, Legal, Privacy, and Protection Services Operations Center to respond to and support cyber crisis situations

• Develop, enhance, and improve enterprise crisis management, cyber response while supporting incident plans and state-specific response plans. Ensure annual plan compliance requirements are achieved

• Implement processes, procedures and systems that will help ensure that the company's continuity capabilities remain in compliance with all laws, regulations, and best practices.

• Assist in the evaluation, design and deployment of integrated systems and technology that support response, intelligence, service delivery and organizational strategy.

• Maintain roster of cyber crisis management and incident response team members

• Conduct annual training of all crisis management and incident response plans or as changes to each location team. Prepare comprehensive, timely, and detailed test reports

• Maintain lessons learned and remediation tracker. Ensure items requiring remediation are resolved within a timely manner

• Assist in development of metrics and measurements supporting program evolution, validation, and business awareness

• Other duties as assigned by leadership

Job Qualifications

Required Education:

Bachelor's degree in an applicable field

Required Experience:

• Minimum of 7 years operational experience across crisis management, resilience and cybersecurity incident response disciplines

• 5 years of corporate business experience in Cyber Response, Incident Response, Crisis management, Disaster Recovery, and Resilience.

• Experience conducting risk assessments, business process or control auditing.

• Strong documentation skills - detailed tracking, executive briefings, and reports, etc.

• Practical understanding of technical/security concepts such as network architecture design, logical access controls, vulnerability management, encryption, and cloud computing.

• Problem solving and analytical abilities including the ability to critically evaluate information gathered from multiple sources, reconcile conflicts, decompose high-level information into details and apply sound business knowledge.

• Strong organizational, interpersonal, analytical, verbal, and written communication skills are essential.

• Ability to build and maintain customer relationships; strong team player, able to meet deadlines and adjust to changing priorities.

• Demonstrated focus on process development and implementation that spans organizational boundaries.

• Self-starter with ability to work independently and to manage multiple tasks/projects in a disciplined and organized fashion while maintaining attention to detail.

• Ability to work collaboratively with team members, some of which may be geographically distributed.

• Power BI experience a plus

• BC in the Cloud, Everbridge and Envoy platform/tool experience

• Familiar with Kroll, CrowdStrike, or other forensics/cyber investigation providers

Required Licensure or Certification:

Required Knowledge, Skills, and Abilities:

• A strong grasp and hands-on experience in cyber incident response, disaster response and crisis management

• Understand cyber response and recovery stages and the fundamentals of incident response planning, testing, exercises

• Situational awareness and responding to incidents that pose a threat to company, property, data, or people

• Creation of metrics, reporting and analysis

• Cyber trends - ransomware, malware, phishing, insider threat, etc.

• ChatGPT and CoPilot-using AI for research

• Familiarity with industry best practices and standards for cyber and crisis events

• Project Management

• Experience with industry standard tools and concepts. BC in the Cloud, Everbridge and Envoy platform/tool experience preferred

Preferred Qualifications:

• BCI or DRII certification(s) a plus; Cyber certifications preferred CISA or CISSP

• Master's degree preferred.

Travel Requirements:

Air Travel: 5-10%

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

*This role will work 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: $16.5 - $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

Works with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. Assesses members for care needs, and develops treatment plan with practitioners, providers, members and support system. Ensures quality member care is provided. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. May coordinate for medical service/appointments once discharge is complete and make the necessary community resource referrals.

*Weekend and/or Weeknight Shift *

Knowledge/Skills/Abilities

- Provides computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: eligibility and benefits verification, provider contracting status, and diagnosis and treatment requests.

- Provides the following additional data entry: Coordination of Benefits status determination, hospital census information regarding admissions and discharges, and billing codes.

- Responds to requests for authorization of services submitted via phone, fax and mail according to Molina operational timeframes.

- Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.

- Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director..

Job Qualifications

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

3-5 years

Preferred License, Certification, Association

Certification in Coding, auditing or billing

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

Works with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. Assesses members for care needs, and develops treatment plan with practitioners, providers, members and support system. Ensures quality member care is provided. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. May coordinate for medical service/appointments once discharge is complete and make the necessary community resource referrals.

*Weekend and/or Weeknight Shift *

Knowledge/Skills/Abilities

- Provides computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: eligibility and benefits verification, provider contracting status, and diagnosis and treatment requests.

- Provides the following additional data entry: Coordination of Benefits status determination, hospital census information regarding admissions and discharges, and billing codes.

- Responds to requests for authorization of services submitted via phone, fax and mail according to Molina operational timeframes.

- Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.

- Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director..

Job Qualifications

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

3-5 years

Preferred License, Certification, Association

Certification in Coding, auditing or billing

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

Works with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. Assesses members for care needs, and develops treatment plan with practitioners, providers, members and support system. Ensures quality member care is provided. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. May coordinate for medical service/appointments once discharge is complete and make the necessary community resource referrals.

*Weekend and/or Weeknight Shift *

Knowledge/Skills/Abilities

- Provides computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: eligibility and benefits verification, provider contracting status, and diagnosis and treatment requests.

- Provides the following additional data entry: Coordination of Benefits status determination, hospital census information regarding admissions and discharges, and billing codes.

- Responds to requests for authorization of services submitted via phone, fax and mail according to Molina operational timeframes.

- Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.

- Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director..

Job Qualifications

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

3-5 years

Preferred License, Certification, Association

Certification in Coding, auditing or billing

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

Works with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. Assesses members for care needs, and develops treatment plan with practitioners, providers, members and support system. Ensures quality member care is provided. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. May coordinate for medical service/appointments once discharge is complete and make the necessary community resource referrals.

*Weekend and/or Weeknight Shift *

Knowledge/Skills/Abilities

- Provides computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: eligibility and benefits verification, provider contracting status, and diagnosis and treatment requests.

- Provides the following additional data entry: Coordination of Benefits status determination, hospital census information regarding admissions and discharges, and billing codes.

- Responds to requests for authorization of services submitted via phone, fax and mail according to Molina operational timeframes.

- Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.

- Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director..

Job Qualifications

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

3-5 years

Preferred License, Certification, Association

Certification in Coding, auditing or billing

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

Works with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. Assesses members for care needs, and develops treatment plan with practitioners, providers, members and support system. Ensures quality member care is provided. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. May coordinate for medical service/appointments once discharge is complete and make the necessary community resource referrals.

*Weekend and/or Weeknight Shift *

Knowledge/Skills/Abilities

- Provides computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: eligibility and benefits verification, provider contracting status, and diagnosis and treatment requests.

- Provides the following additional data entry: Coordination of Benefits status determination, hospital census information regarding admissions and discharges, and billing codes.

- Responds to requests for authorization of services submitted via phone, fax and mail according to Molina operational timeframes.

- Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.

- Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director..

Job Qualifications

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

3-5 years

Preferred License, Certification, Association

Certification in Coding, auditing or billing

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

Works with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. Assesses members for care needs, and develops treatment plan with practitioners, providers, members and support system. Ensures quality member care is provided. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. May coordinate for medical service/appointments once discharge is complete and make the necessary community resource referrals.

*Weekend and/or Weeknight Shift *

Knowledge/Skills/Abilities

- Provides computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: eligibility and benefits verification, provider contracting status, and diagnosis and treatment requests.

- Provides the following additional data entry: Coordination of Benefits status determination, hospital census information regarding admissions and discharges, and billing codes.

- Responds to requests for authorization of services submitted via phone, fax and mail according to Molina operational timeframes.

- Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.

- Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director..

Job Qualifications

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

3-5 years

Preferred License, Certification, Association

Certification in Coding, auditing or billing

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

Molina Healthcare is hiring several Quality Improvement, Auditor RN's and/or LPN' s in Maricopa County. These roles will be in the field +/- 50% of the time doing site Provider visits and onsite auditing.

We are looking for someone who is passionate about patient and member safety.

Someone who understands this is where we can make an immediate difference in members lives by ensure their safety.

Qualified candidates will have the following experience:

• RN or LPN living in Arizona (Maricopa, Gila or Pinal counties)

• Experience in one or more. of the following- Auditing, Quality and/or Regulatory

• Ability to work remote 50% of the time and do field visits/audits 50%.

• Managed Care experience

Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities.

KNOWLEDGE/SKILLS/ABILITIES

The Senior Specialist, Quality Improvement (Registered Nurse) contributes to one or more of these quality improvements functions: Quality Interventions, Quality Improvement Compliance, HEDIS, and / or Quality Reporting.

Quality Intervention / QI Compliance

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

• Implements key quality strategies that require a component of near real-time clinical decision-making. These activities may include initiation and management of interventions (e.g., removing barriers to care); preparation for Quality Improvement Compliance surveys; preparation and review of potential quality of care and critical incident cases; review of medical record documentation for credentialing and model of care oversight; and any other federal and state required quality activities.

• Monitors and ensures that key quality activities that involve clinical decision-making are completed on time and accurately in order to present results to key departmental management and other Molina departments as needed.

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

• Creates, manages, and/or compiles the required documentation to maintain critical quality improvement functions that have a component of clinical decision-making.

• Leads quality improvement activities, meetings, and discussions with and between other departments within the organization. Often the Senior Specialist will be assigned activities where clinical expertise is important to the activity.

• Surfaces to Manager and Director any gaps in processes that may require remediation. In particular, the Senior Specialist may be asked to focus on parts of the process where a clinician's perspective would be valuable to uncover process gaps or limitations.

HEDIS / Quality Reporting

• Performs the lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review. The Senior Specialist will be asked to perform duties where clinical decision-making may be necessary.

• Participates in meetings with vendors for the medical record collection process.

• Assists Manager and Supervisor(s) in training and takes the lead role in these activities

• Collects medical records and reports from provider offices, loads data into the HEDIS application, and compares the documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed.

• Works with the corporate HEDIS team to monitor accuracy of abstracted records as required by specifications.

• Participates in scheduled meetings with the corporate HEDIS team, vendors and HEDIS auditors.

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

• Provides data collection and report development support for quality improvement studies and performance improvement projects.

• Assists as needed in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation.

JOB QUALIFICATIONS

Required Education: Bachelor's degree in nursing or higher

Preferred Education: Preferred field: Clinical Quality, Public Health or Healthcare. Nursing: Master's or higher

Required License, Certification, Association: Active and unrestricted RN license for the State(s) of employment

Required Experience: Min. 3 years' experience in healthcare with minimum 2 years' experience in health plan quality improvement, managed care, or equivalent experience.

Preferred Experience:

• 2 years coding and medical record abstraction experience.

• 1-year managed care experience.

• Basic knowledge of HEDIS and NCQA.

Preferred License, Certification, Association

• Certified Professional in Health Quality (CPHQ)

• Certified HEDIS Compliance Auditor (CHCA)

• Registered Health Information Technician (RHIT), or

• Certified Medical Record Technician with training in coding procedures (as required by state/location only), or

• Certified Professional Coder (CPC)

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

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer

(EOE) M/F/D/V.

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

The Care Connections Skilled Nursing Facility (SNF) Nurse Practitioners focus on screening and preventive primary care services delivered in the community and assisted living/nursing facility settings.

The SNF NP will be required to work primarily in facilities and provide medical care to all levels of patients. The SNF NP will have specific focus on quality initiatives such as decreasing length of stay, pressure ulcers, and other clinical programs.

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/Essential Job Functions

- 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

- The NP is responsible for knowing when a patient needs nurse practitioner or physician oversight and when the patient's medical condition may be beyond the scope of knowledge of the NP.

- 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 assisted living facilities, skilled nursing facilities, and other facility locations

- Integrating into care provided for Molina residents by being initial point of contact for change of conditions during business hours

- Routinely reviewing and updating medications and care plans to ensure consistent with latest evidence or best practices and the resident's wishes and goals

- Completing RCA with facility team for events impacting the VBR measures

- Collaborating with facility staff including residents, their designated Resident Representatives or family members, Attending and consulting physicians

- Working collaboratively with Network Clinical Care Manager to track VBR progress and opportunities for early intervention at the resident level, as well as facility system-wide

- Providing just in time feedback and education to the staff on best clinical practices

- 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 wide variety of locations and neighborhoods 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 efficiently and effectively perform work duties

- 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:

- 1-2 years' experience as a Nurse Practitioner.

- 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, Adult Gerontology, Acute Care Nurse Practitioner

- Current Basic Life Support for Healthcare Professional certification

- Current unrestricted driver's license

PREFERRED EXPERIENCE:

- 3-5-year experience as a Nurse Practitioner, ideally in a SNF or inpatient 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

STATE SPECIFIC REQUIREMENTS:

Engage in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician to the degree required by state laws. May also function as and perform all duties reasonably expected and assigned to an RN such medication administration.

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: $79,607.9 - $172,483.79 / 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

Works with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. Assesses members for care needs, and develops treatment plan with practitioners, providers, members and support system. Ensures quality member care is provided. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. May coordinate for medical service/appointments once discharge is complete and make the necessary community resource referrals.

*Weekend and/or Weeknight Shift *

Knowledge/Skills/Abilities

- Provides computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: eligibility and benefits verification, provider contracting status, and diagnosis and treatment requests.

- Provides the following additional data entry: Coordination of Benefits status determination, hospital census information regarding admissions and discharges, and billing codes.

- Responds to requests for authorization of services submitted via phone, fax and mail according to Molina operational timeframes.

- Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.

- Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director..

Job Qualifications

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

3-5 years

Preferred License, Certification, Association

Certification in Coding, auditing or billing

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

Works with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. Assesses members for care needs, and develops treatment plan with practitioners, providers, members and support system. Ensures quality member care is provided. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. May coordinate for medical service/appointments once discharge is complete and make the necessary community resource referrals.

*Weekend and/or Weeknight Shift *

Knowledge/Skills/Abilities

- Provides computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: eligibility and benefits verification, provider contracting status, and diagnosis and treatment requests.

- Provides the following additional data entry: Coordination of Benefits status determination, hospital census information regarding admissions and discharges, and billing codes.

- Responds to requests for authorization of services submitted via phone, fax and mail according to Molina operational timeframes.

- Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.

- Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director..

Job Qualifications

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

3-5 years

Preferred License, Certification, Association

Certification in Coding, auditing or billing

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

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

Pay Range: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

Molina's Quality Improvement Lead Abstractor conducts data collection and abstraction of medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The lead abstraction team will meet chart abstraction productivity standards, minimum over read standards, as well as working alongside their leadership team to mentor abstractors, lead projects and ensure project completeness.

Job Duties

• Performs the lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review.

• Leads meetings with vendors for the medical record collection process.

• Assists Manager and Supervisor(s) in training, utilizing the standardized training materials and job aids.

• As needed, may collect medical records and reports from provider offices, loads data into the HEDIS application, and compares the documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed.

• Works with the National Over read team to monitor accuracy of abstracted records as required by specifications.

• Participates and leads scheduled meetings with the National Over read team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results.

• Mentor entry and Sr. level abstractors.

• Works with the Manager to monitor accuracy of abstracted records as required by specifications.

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

• Assists as needed in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation.

• Provides data collection, presentations and report development support for quality improvement studies and performance improvement projects.

• Leads projects and process improvement initiatives.

Job Qualifications

REQU I RED ED U C A TI O N :

Bachelor's degree or equivalent experience

REQU I RED E X PE R I E N C E/KNOWLEDGE, SKILLS & ABILITIES:

• 5 years experience in healthcare Quality/HEDIS specific to medical record review and abstraction

• Intermediate knowledge of HEDIS and NCQA

PR E FE R RED E X PE R I E N C E:

• 3+ years of medical record abstraction experience

• 3+ years managed care experience.

• Advanced knowledge of HEDIS and NCQA.

PR E FE R RED L I C E N S E, C E R TI FI C A T I O N , AS S O C I A TI O N :

Active RN license for the State(s) of employment

PHY S I C AL DEM A N D S :

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: $21.6 - $46.81 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare