Company Detail

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

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

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

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

Molina Healthcare is hiring for several Community Connectors in New York!

Queens, Brooklyn, Staten Island, Bronx, and Manhattan preferred.

Bilingual in English and any of the following: Bengali, Korean, Spanish, Russian or Chinese needed!

This role will be the non-clinical support for the Health Care Services team. Duties will include (but not be limited) to the following:

• Be the -Face of Molina- to our members via the telephone. Handling both outbound and inbound calls to members to ensure they are getting the care and services needed. This includes introducing them to the Molina Case Management team.

• Reaching out to members to conduct post discharge screening. Referring members to the appropriate departments depending on the outcome of the screening, assisting with Health Risk screenings, and required screenings.

• Assisting with reviewing additional program and special projects as needed and other duties as assigned.

Highly qualified applicants will have the following experience:

• Must live in one of the five New York boroughs.

• Must have a New York State Drivers license or ID Card issued by the state.

• Familiarity with heath care systems, social services, and community resources. (Bonus, but not required in Managed Care, Medicaid, Health Plan or Health Insurance etc..)

• Be bilingual with great communication skills in English and any of the following languages; Bengali, Korean, Spanish, Russian, or Chinese.

• Great computer skills, including being able to navigate between different system, taking notes while on the phone with members, and being able to use Excel above a beginner level.

• Previous experience in a phone customer service role, meeting and exceeding metrics and goals.

• Ability to be a team player and also work independently.

• Great communication, both written and verbal.

• Able to display empathy and compassion for the members we serve.

• Must have a valid driver's license and a reliable vehicle. This role is currently remote but may have the ability to see members face to face at a later time.

If you live in/near the areas listed and enjoy being involved in and helping your community- We want to talk to YOU! This very important role will help others obtain the support necessary to better manage their health and wellbeing-

KNOWLEDGE/SKILLS/ABILITIES

• 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.

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

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

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

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

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

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

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

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

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

• #LI-TR1

REQUIRED EDUCATION: HS Diploma/GED

PREFERRED EDUCATION: Associate's degree in a health care related field (e.g., nutrition, counseling, social work).

REQUIRED EXPERIENCE:

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

PREFERRED EXPERIENCE:

• Bilingual based on community need.

• Familiarity with healthcare systems a plus.

• Knowledge of community-specific culture.

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

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 LICENSE, CERTIFICATION, ASSOCIATION:

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

• Active and unrestricted Medical Assistant Certification

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

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

Key Words: Home Care, LTSS, Long Term Care, Medical Assistant, Community Connector, Nonclinical Case Manager, Care Manager, Community Engagement, Public Health, Healthcare, Health Care, Managed Care, MCO, Medicaid, Medicare, HEDIS, CAPHS, equity community health advisor, family advocate, advocacy, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter, public health aide, community lead, community advocate, nonprofit, non-profit, social worker, case worker, housing counselor, human service worker, Navigator, Assistor, Connecter, Promotora, Marketing, managed care, MCO, member, market, screening, education, educating, Bilingual, Trilingual, Chinese, Russian, Bengali, Korean, Spanish, CSR, Customer Service Rep,

Pay Range: $16 - $31.97 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare is hiring for several Community Connectors in New York!

Queens, Brooklyn, Staten Island, Bronx, and Manhattan preferred.

Bilingual in English and any of the following: Bengali, Korean, Spanish, Russian or Chinese needed!

This role will be the non-clinical support for the Health Care Services team. Duties will include (but not be limited) to the following:

• Be the -Face of Molina- to our members via the telephone. Handling both outbound and inbound calls to members to ensure they are getting the care and services needed. This includes introducing them to the Molina Case Management team.

• Reaching out to members to conduct post discharge screening. Referring members to the appropriate departments depending on the outcome of the screening, assisting with Health Risk screenings, and required screenings.

• Assisting with reviewing additional program and special projects as needed and other duties as assigned.

Highly qualified applicants will have the following experience:

• Must live in one of the five New York boroughs.

• Must have a New York State Drivers license or ID Card issued by the state.

• Familiarity with heath care systems, social services, and community resources. (Bonus, but not required in Managed Care, Medicaid, Health Plan or Health Insurance etc..)

• Be bilingual with great communication skills in English and any of the following languages; Bengali, Korean, Spanish, Russian, or Chinese.

• Great computer skills, including being able to navigate between different system, taking notes while on the phone with members, and being able to use Excel above a beginner level.

• Previous experience in a phone customer service role, meeting and exceeding metrics and goals.

• Ability to be a team player and also work independently.

• Great communication, both written and verbal.

• Able to display empathy and compassion for the members we serve.

• Must have a valid driver's license and a reliable vehicle. This role is currently remote but may have the ability to see members face to face at a later time.

If you live in/near the areas listed and enjoy being involved in and helping your community- We want to talk to YOU! This very important role will help others obtain the support necessary to better manage their health and wellbeing-

KNOWLEDGE/SKILLS/ABILITIES

• 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.

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

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

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

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

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

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

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

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

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

• #LI-TR1

REQUIRED EDUCATION: HS Diploma/GED

PREFERRED EDUCATION: Associate's degree in a health care related field (e.g., nutrition, counseling, social work).

REQUIRED EXPERIENCE:

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

PREFERRED EXPERIENCE:

• Bilingual based on community need.

• Familiarity with healthcare systems a plus.

• Knowledge of community-specific culture.

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

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 LICENSE, CERTIFICATION, ASSOCIATION:

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

• Active and unrestricted Medical Assistant Certification

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

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

Key Words: Home Care, LTSS, Long Term Care, Medical Assistant, Community Connector, Nonclinical Case Manager, Care Manager, Community Engagement, Public Health, Healthcare, Health Care, Managed Care, MCO, Medicaid, Medicare, HEDIS, CAPHS, equity community health advisor, family advocate, advocacy, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter, public health aide, community lead, community advocate, nonprofit, non-profit, social worker, case worker, housing counselor, human service worker, Navigator, Assistor, Connecter, Promotora, Marketing, managed care, MCO, member, market, screening, education, educating, Bilingual, Trilingual, Chinese, Russian, Bengali, Korean, Spanish, CSR, Customer Service Rep,

Pay Range: $16 - $31.97 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare is hiring for several Community Connectors in New York!

Queens, Brooklyn, Staten Island, Bronx, and Manhattan preferred.

Bilingual in English and any of the following: Bengali, Korean, Spanish, Russian or Chinese needed!

This role will be the non-clinical support for the Health Care Services team. Duties will include (but not be limited) to the following:

• Be the -Face of Molina- to our members via the telephone. Handling both outbound and inbound calls to members to ensure they are getting the care and services needed. This includes introducing them to the Molina Case Management team.

• Reaching out to members to conduct post discharge screening. Referring members to the appropriate departments depending on the outcome of the screening, assisting with Health Risk screenings, and required screenings.

• Assisting with reviewing additional program and special projects as needed and other duties as assigned.

Highly qualified applicants will have the following experience:

• Must live in one of the five New York boroughs.

• Must have a New York State Drivers license or ID Card issued by the state.

• Familiarity with heath care systems, social services, and community resources. (Bonus, but not required in Managed Care, Medicaid, Health Plan or Health Insurance etc..)

• Be bilingual with great communication skills in English and any of the following languages; Bengali, Korean, Spanish, Russian, or Chinese.

• Great computer skills, including being able to navigate between different system, taking notes while on the phone with members, and being able to use Excel above a beginner level.

• Previous experience in a phone customer service role, meeting and exceeding metrics and goals.

• Ability to be a team player and also work independently.

• Great communication, both written and verbal.

• Able to display empathy and compassion for the members we serve.

• Must have a valid driver's license and a reliable vehicle. This role is currently remote but may have the ability to see members face to face at a later time.

If you live in/near the areas listed and enjoy being involved in and helping your community- We want to talk to YOU! This very important role will help others obtain the support necessary to better manage their health and wellbeing-

KNOWLEDGE/SKILLS/ABILITIES

• 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.

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

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

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

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

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

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

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

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

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

• #LI-TR1

REQUIRED EDUCATION: HS Diploma/GED

PREFERRED EDUCATION: Associate's degree in a health care related field (e.g., nutrition, counseling, social work).

REQUIRED EXPERIENCE:

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

PREFERRED EXPERIENCE:

• Bilingual based on community need.

• Familiarity with healthcare systems a plus.

• Knowledge of community-specific culture.

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

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 LICENSE, CERTIFICATION, ASSOCIATION:

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

• Active and unrestricted Medical Assistant Certification

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

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

Key Words: Home Care, LTSS, Long Term Care, Medical Assistant, Community Connector, Nonclinical Case Manager, Care Manager, Community Engagement, Public Health, Healthcare, Health Care, Managed Care, MCO, Medicaid, Medicare, HEDIS, CAPHS, equity community health advisor, family advocate, advocacy, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter, public health aide, community lead, community advocate, nonprofit, non-profit, social worker, case worker, housing counselor, human service worker, Navigator, Assistor, Connecter, Promotora, Marketing, managed care, MCO, member, market, screening, education, educating, Bilingual, Trilingual, Chinese, Russian, Bengali, Korean, Spanish, CSR, Customer Service Rep,

Pay Range: $16 - $31.97 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

This position will support our Senior Whole Health business. Senior Whole Health by Molina is a Managed Long-Term Care (MLTC)plan. These plans streamline the delivery of long-term services to chronically ill or disabled people who are eligible for Medicaid . We are looking for a RN Care Review Clinician with Prior Authorization experience. Candidates with Utilization Management (UM) and MLTC/LTC experience are highly preferred. Additional experience with appeals, quality review, and experience with data collection/reports. Bilingual candidates that speak Spanish or Mandarin are encouraged to apply.

Work hours: Monday - Friday 8:30AM- 5:00PM EST

Remote position with light travel- 10-15% for in person meeting at the Bronx office location.

KNOWLEDGE/SKILLS/ABILITIES

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

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

• Identifies appropriate benefits and eligibility for requested treatments and/or procedures.

• Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.

• Processes requests within required timelines.

• Refers appropriate prior authorization requests to Medical Directors.

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

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model

• Adheres to UM policies and procedures.

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

• Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.

JOB QUALIFICATIONS

Required Education

Completion of an accredited Registered Nurse (RN).

Required Experience

1-3 years of hospital or medical clinic experience.

MLTC/LTC experience

UM experience

Experience with appeals, quality review, and with data collection/reports

Required License, Certification, Association

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

NY RN license

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

• 25- 40% local travel required.

• RNs provide consultation, recommendations and education as appropriate to non-RN case managers.

• RNs are assigned cases with members who have complex medical conditions and medication regimens

• RNs conduct medication reconciliation when needed.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

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

Required License, Certification, Association

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

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Certified Case Manager (CCM)

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

• 25- 40% local travel required.

• RNs provide consultation, recommendations and education as appropriate to non-RN case managers.

• RNs are assigned cases with members who have complex medical conditions and medication regimens

• RNs conduct medication reconciliation when needed.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

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

Required License, Certification, Association

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

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Certified Case Manager (CCM)

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

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

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

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

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

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

• Required License, Certification, Association

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

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

State Specific Requirements

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

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

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

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

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

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

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

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

• Required License, Certification, Association

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

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

State Specific Requirements

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

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

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

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

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

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

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

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

• Required License, Certification, Association

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

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

State Specific Requirements

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

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

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

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

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

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

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

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

• Required License, Certification, Association

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

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

State Specific Requirements

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

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

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

• Completes 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 TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSE

For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. CALIFORNIA LICENSURE IS REQUIRED FOR THIS ROLE IMMEDIATELY UPON HIRE. CALIFORNIA IS NOT A COMPACT STATE AT THIS TIME. Excellent computer multi tasking skills and analytical thought process is important to be successful in this role. Productivity is important with turnaround times.

Home office with private desk area, and high speed internet connectivity required.

This department operates 365 days a year and we need staff who can be flexible and willing to work some weekends and holidays. This is a remote position and you may work from home. Please consider that scheduling flexibility is important before you apply to this role.

WORK SCHEDULE: 5 days / daytime work schedule M - F 8:30AM to 5:30PM PACIFIC, with some weekends and holidays. Candidates who do not live in PACIFIC Time Zone must work PACIFIC hours as stated.

Further details to be discussed during our interview process.

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

• Processes requests within required timelines.

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

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

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

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

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

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

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

State Specific Requirements:

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management.

Job Duties

• Active collaborator with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion.

• Plans and directs schedules as well as project budgets.

• Monitors the project from inception through delivery.

• May engage and oversee the work of external vendors.

• Focuses on process improvement, organizational change management, program management and other processes relative to the business.

• Leads and manages team in planning and executing business programs.

• Serves as the subject matter expert in the functional area and leads programs to meet critical needs.

• Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed.

• Works with operational leaders within the business to provide recommendations on opportunities for process improvements.

• Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.

• Generate and distribute standard reports on schedule

JOB QUALIFICATIONS

REQUIRED EDUCATION :

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

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

• 3-5 years of Program and/or Project management experience.

• Operational Process Improvement experience.

• Healthcare experience.

• Experience with Microsoft Project and Visio.

• Excellent presentation and communication skills.

• Experience partnering with different levels of leadership across the organization.

PREFERRED EDUCATION :

Graduate Degree or equivalent combination of education and experience.

PREFERRED EXPERIENCE :

- 5-7 years of Program and/or Project management experience.

- Managed Care experience.

- Experience working in a cross functional highly matrixed organization.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :

- PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification and/or comparable coursework desired.

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

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations.

Knowledge/Skills/Abilities

- Assists with implementation and day-to-day operations of the Compliance Program, Compliance Plan, Code of Conduct, and Fraud, Waste and Abuse Plan across the enterprise while ensuring compliance with governmental requirements.

- Spearheads development and implementation of compliance policies and procedures and training programs for the Molina enterprise.

- Oversees and provides direction of site visits for regulatory audits and coordinates corrective action plan, as needed.

- Investigates and resolves compliance problems, questions, or complaints received internally or from customers/agencies.

- Provides input and representation on key compliance initiatives, meetings, and committees. Stays abreast of industry and compliance trends; recommends and implements changes to internal company processes as needed..

Job Qualifications

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

5-7 years

Preferred Education

Masters Degree preferred; will consider previous experience in health plan setting in government programs management (Contract Manager)

Preferred Experience

7-9 years

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

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

We are seeking RN (Registered Nurse), who must live in the CINCINNATI OHIO area, and must be licensed for the state of OHIO. 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 working with our Medicare Waiver Population. This role will require telephonic and face to face assessments with members.

TRAVEL in the field to do member visits in the surrounding areas will be required. Mileage will be reimbursed.

Home office with internet connectivity of high speed required.

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

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

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

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

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

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

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

• Required License, Certification, Association

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

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

State Specific Requirements

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

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

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

• Completes 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

This position will support our MMP (Medicaid Medicare Population) that is part of the Community Well Services team. This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent computer skills and diligence are especially 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. This position requires field work doing assessments with members face to face in homes.

TRAVEL in the field to do member visits in the surrounding areas will be required: Wayne County

Travel will be up to 25% of the time (Mileage is reimbursed)

Schedule - Monday thru Friday 830 AM to 5 PM EST (No weekends or Holidays)

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

• 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

Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management.

Job Duties

• Active collaborator with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion.

• Plans and directs schedules as well as project budgets.

• Monitors the project from inception through delivery.

• May engage and oversee the work of external vendors.

• Focuses on process improvement, organizational change management, program management and other processes relative to the business.

• Leads and manages team in planning and executing business programs.

• Serves as the subject matter expert in the functional area and leads programs to meet critical needs.

• Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed.

• Works with operational leaders within the business to provide recommendations on opportunities for process improvements.

• Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.

• Generate and distribute standard reports on schedule

JOB QUALIFICATIONS

REQUIRED EDUCATION :

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

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

• 3-5 years of Program and/or Project management experience.

• Operational Process Improvement experience.

• Healthcare experience.

• Experience with Microsoft Project and Visio.

• Excellent presentation and communication skills.

• Experience partnering with different levels of leadership across the organization.

PREFERRED EDUCATION :

Graduate Degree or equivalent combination of education and experience.

PREFERRED EXPERIENCE :

- 5-7 years of Program and/or Project management experience.

- Managed Care experience.

- Experience working in a cross functional highly matrixed organization.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :

- PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification and/or comparable coursework desired.

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

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management.

Job Duties

• Active collaborator with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion.

• Plans and directs schedules as well as project budgets.

• Monitors the project from inception through delivery.

• May engage and oversee the work of external vendors.

• Focuses on process improvement, organizational change management, program management and other processes relative to the business.

• Leads and manages team in planning and executing business programs.

• Serves as the subject matter expert in the functional area and leads programs to meet critical needs.

• Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed.

• Works with operational leaders within the business to provide recommendations on opportunities for process improvements.

• Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.

• Generate and distribute standard reports on schedule

JOB QUALIFICATIONS

REQUIRED EDUCATION :

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

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

• 3-5 years of Program and/or Project management experience.

• Operational Process Improvement experience.

• Healthcare experience.

• Experience with Microsoft Project and Visio.

• Excellent presentation and communication skills.

• Experience partnering with different levels of leadership across the organization.

PREFERRED EDUCATION :

Graduate Degree or equivalent combination of education and experience.

PREFERRED EXPERIENCE :

- 5-7 years of Program and/or Project management experience.

- Managed Care experience.

- Experience working in a cross functional highly matrixed organization.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :

- PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification and/or comparable coursework desired.

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

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

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