Company Detail

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

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

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

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

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

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

Job Summary

Provides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions, and complaints. Resolves member inquiries and complaints fairly and effectively. Provides product and service information to members and identifies opportunities to maintain and increase member relationships. Recommends and implements programs to support member needs.

KNOWLEDGE/SKILLS/ABILITIES

• Performs member outreach calls in states supported by Molina Healthcare to enforce member retention

• Answers incoming calls regarding Medicaid members in PEND status and those having Re-determination renewal dates.

• Helps members complete necessary paperwork related to either Medicaid eligibility renewal process.

• Assists Medicaid Members in contacting their social worker regarding eligibility issues and follow-up with members to ensure follow through, if allowed by the member's respective state.

• Accurately and timely documents member retention contacts in appropriate database.

JOB QUALIFICATIONS

Required Education

HS Diploma

Required Experience

1-3 years

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 Education

Associate's Degree

Preferred Experience

3-5 years

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

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

Pay Range: $15 - $26.42 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Overview

The Associate Vice President of Call Center Operations plays a critical role in managing and optimizing call center operations, with a focus on supporting Medicare-related services. As an AVP, you'll lead a team responsible for delivering exceptional customer service to Medicare beneficiaries.

Responsibilities:

Strategic Leadership

• Develop and execute strategies to enhance call center performance, ensuring efficient handling of Medicare inquiries, claims, and member services.

• Collaborate with cross-functional teams to align call center operations with Medicare compliance and quality standards.

Operational Excellence

• Oversee day-to-day call center activities, including call volume management, workforce planning, and performance metrics.

• Implement best practices to improve efficiency, accuracy, and member satisfaction.

• Responsible for ensuring teams deliver effective customer service for all service needs including benefits, claims, billing inquiries, service requests, suggestions, and complaints.

• Directly and through team members resolves both member and provider inquiries and complaints fairly and effectively.

• Provides direction and coordination to deliver accurate product and service information to members and providers and identifies opportunities to increase membership by improving our member and provider experience.

• Recommends and implements programs to support member and provider needs. Works within a matrix environment with dotted line relationships across multiple lines of business.

• Ensure leaders and staff are working on retention and expansion initiatives.

• Ensure compliance with Medicare guidelines and regulations.

• Drives and maintains relationships with all contact center vendors to drive performance excellence. Provides leadership and oversight of all call center vendors, including ensuring all outsourced call center vendors meet all key performance indicators and contractual requirements.

Quality Assurance

• Monitor call center interactions to maintain high-quality service.

• Implement quality control processes and provide feedback to agents.

• Address escalated issues promptly.

Technology and Process Improvement:

• Evaluate call center technologies and tools to enhance productivity and member experience.

• Identify process bottlenecks and recommend improvements.

Stakeholder Collaboration:

• Work closely with Medicare program managers, compliance officers, and other relevant stakeholders.

• Provide regular updates on call center performance and initiatives.

Job Qualifications

Education : Bachelor's degree (advanced degrees preferred).

10 years of experience:

• Proven leadership experience in healthcare operations, preferably call center operations within the Medicare and MMP domain. Experience preferred with dual eligible (Medicare-Medicaid) population.

• Familiarity with Medicare regulations, policies, and procedures.

• Strong analytical skills and ability to drive process improvements.

• Excellent communication and collaboration skills.

• Previous experience managing staff, including hiring, training, managing workload and performance.

• Experience in managing a large-scale call center with remote staffing preferred.

• Experience in improving CTM performance and impact, as well as driving Customer Satisfaction (NPS) Improvement.

#PJCC

#LI-AC1

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: $140,795 - $274,550.26 / 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's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information.

Job Duties

- Evaluates credentialing applications for accuracy and completeness based on differences in provider specialty and obtains required verifications as outlined in Molina policies/procedures and regulatory requirements, while meeting production goals.

- Communicates with health care providers to clarify questions and request any missing information.

- Updates credentialing software systems with required information.

- Requests recredentialing applications from providers and conducts follow-up on application requests, following department guidelines and production goals.

- Collaborates with internal and external contacts to ensure timely processing or termination of recredentialing applicants.

- Completes data corrections in the credentialing database necessary for processing of recredentialing applications.

- Reviews claims payment systems to determine provider status, as necessary.

- Completes follow-up for provider files on 'watch' status, as necessary, following department guidelines and production goals.

- Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions.

- Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare.

- Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found.

JOB QUALIFICATIONS

Required Education:

High School Diploma or GED.

Required Experience/Knowledge Skills & Abilities

- Experience in a production or administrative role requiring self-direction and critical thinking.

- Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems.

- Experience with professional written and verbal communication.

Preferred Experience:

Experience in the health care industry

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

#PJHPO

Pay Range: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information.

Job Duties

- Evaluates credentialing applications for accuracy and completeness based on differences in provider specialty and obtains required verifications as outlined in Molina policies/procedures and regulatory requirements, while meeting production goals.

- Communicates with health care providers to clarify questions and request any missing information.

- Updates credentialing software systems with required information.

- Requests recredentialing applications from providers and conducts follow-up on application requests, following department guidelines and production goals.

- Collaborates with internal and external contacts to ensure timely processing or termination of recredentialing applicants.

- Completes data corrections in the credentialing database necessary for processing of recredentialing applications.

- Reviews claims payment systems to determine provider status, as necessary.

- Completes follow-up for provider files on 'watch' status, as necessary, following department guidelines and production goals.

- Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions.

- Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare.

- Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found.

JOB QUALIFICATIONS

Required Education:

High School Diploma or GED.

Required Experience/Knowledge Skills & Abilities

- Experience in a production or administrative role requiring self-direction and critical thinking.

- Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems.

- Experience with professional written and verbal communication.

Preferred Experience:

Experience in the health care industry

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

#PJHPO

Pay Range: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Overview

The Associate Vice President of Call Center Operations plays a critical role in managing and optimizing call center operations, with a focus on supporting Medicare-related services. As an AVP, you'll lead a team responsible for delivering exceptional customer service to Medicare beneficiaries.

Responsibilities:

Strategic Leadership

• Develop and execute strategies to enhance call center performance, ensuring efficient handling of Medicare inquiries, claims, and member services.

• Collaborate with cross-functional teams to align call center operations with Medicare compliance and quality standards.

Operational Excellence

• Oversee day-to-day call center activities, including call volume management, workforce planning, and performance metrics.

• Implement best practices to improve efficiency, accuracy, and member satisfaction.

• Responsible for ensuring teams deliver effective customer service for all service needs including benefits, claims, billing inquiries, service requests, suggestions, and complaints.

• Directly and through team members resolves both member and provider inquiries and complaints fairly and effectively.

• Provides direction and coordination to deliver accurate product and service information to members and providers and identifies opportunities to increase membership by improving our member and provider experience.

• Recommends and implements programs to support member and provider needs. Works within a matrix environment with dotted line relationships across multiple lines of business.

• Ensure leaders and staff are working on retention and expansion initiatives.

• Ensure compliance with Medicare guidelines and regulations.

• Drives and maintains relationships with all contact center vendors to drive performance excellence. Provides leadership and oversight of all call center vendors, including ensuring all outsourced call center vendors meet all key performance indicators and contractual requirements.

Quality Assurance

• Monitor call center interactions to maintain high-quality service.

• Implement quality control processes and provide feedback to agents.

• Address escalated issues promptly.

Technology and Process Improvement:

• Evaluate call center technologies and tools to enhance productivity and member experience.

• Identify process bottlenecks and recommend improvements.

Stakeholder Collaboration:

• Work closely with Medicare program managers, compliance officers, and other relevant stakeholders.

• Provide regular updates on call center performance and initiatives.

Job Qualifications

Education : Bachelor's degree (advanced degrees preferred).

10 years of experience:

• Proven leadership experience in healthcare operations, preferably call center operations within the Medicare and MMP domain. Experience preferred with dual eligible (Medicare-Medicaid) population.

• Familiarity with Medicare regulations, policies, and procedures.

• Strong analytical skills and ability to drive process improvements.

• Excellent communication and collaboration skills.

• Previous experience managing staff, including hiring, training, managing workload and performance.

• Experience in managing a large-scale call center with remote staffing preferred.

• Experience in improving CTM performance and impact, as well as driving Customer Satisfaction (NPS) Improvement.

#PJCC

#LI-AC1

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: $140,795 - $274,550.26 / 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's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information.

Job Duties

- Evaluates credentialing applications for accuracy and completeness based on differences in provider specialty and obtains required verifications as outlined in Molina policies/procedures and regulatory requirements, while meeting production goals.

- Communicates with health care providers to clarify questions and request any missing information.

- Updates credentialing software systems with required information.

- Requests recredentialing applications from providers and conducts follow-up on application requests, following department guidelines and production goals.

- Collaborates with internal and external contacts to ensure timely processing or termination of recredentialing applicants.

- Completes data corrections in the credentialing database necessary for processing of recredentialing applications.

- Reviews claims payment systems to determine provider status, as necessary.

- Completes follow-up for provider files on 'watch' status, as necessary, following department guidelines and production goals.

- Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions.

- Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare.

- Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found.

JOB QUALIFICATIONS

Required Education:

High School Diploma or GED.

Required Experience/Knowledge Skills & Abilities

- Experience in a production or administrative role requiring self-direction and critical thinking.

- Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems.

- Experience with professional written and verbal communication.

Preferred Experience:

Experience in the health care industry

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

#PJHPO

Pay Range: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Overview

The Associate Vice President of Call Center Operations plays a critical role in managing and optimizing call center operations, with a focus on supporting Medicare-related services. As an AVP, you'll lead a team responsible for delivering exceptional customer service to Medicare beneficiaries.

Responsibilities:

Strategic Leadership

• Develop and execute strategies to enhance call center performance, ensuring efficient handling of Medicare inquiries, claims, and member services.

• Collaborate with cross-functional teams to align call center operations with Medicare compliance and quality standards.

Operational Excellence

• Oversee day-to-day call center activities, including call volume management, workforce planning, and performance metrics.

• Implement best practices to improve efficiency, accuracy, and member satisfaction.

• Responsible for ensuring teams deliver effective customer service for all service needs including benefits, claims, billing inquiries, service requests, suggestions, and complaints.

• Directly and through team members resolves both member and provider inquiries and complaints fairly and effectively.

• Provides direction and coordination to deliver accurate product and service information to members and providers and identifies opportunities to increase membership by improving our member and provider experience.

• Recommends and implements programs to support member and provider needs. Works within a matrix environment with dotted line relationships across multiple lines of business.

• Ensure leaders and staff are working on retention and expansion initiatives.

• Ensure compliance with Medicare guidelines and regulations.

• Drives and maintains relationships with all contact center vendors to drive performance excellence. Provides leadership and oversight of all call center vendors, including ensuring all outsourced call center vendors meet all key performance indicators and contractual requirements.

Quality Assurance

• Monitor call center interactions to maintain high-quality service.

• Implement quality control processes and provide feedback to agents.

• Address escalated issues promptly.

Technology and Process Improvement:

• Evaluate call center technologies and tools to enhance productivity and member experience.

• Identify process bottlenecks and recommend improvements.

Stakeholder Collaboration:

• Work closely with Medicare program managers, compliance officers, and other relevant stakeholders.

• Provide regular updates on call center performance and initiatives.

Job Qualifications

Education : Bachelor's degree (advanced degrees preferred).

10 years of experience:

• Proven leadership experience in healthcare operations, preferably call center operations within the Medicare and MMP domain. Experience preferred with dual eligible (Medicare-Medicaid) population.

• Familiarity with Medicare regulations, policies, and procedures.

• Strong analytical skills and ability to drive process improvements.

• Excellent communication and collaboration skills.

• Previous experience managing staff, including hiring, training, managing workload and performance.

• Experience in managing a large-scale call center with remote staffing preferred.

• Experience in improving CTM performance and impact, as well as driving Customer Satisfaction (NPS) Improvement.

#PJCC

#LI-AC1

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: $140,795 - $274,550.26 / ANNUAL

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

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

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

Job Duties

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

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

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

• Establish and document reasonable medical diagnoses

• Seek specialty consultation as appropriate

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

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

• Create and implements a medical plan of care

• Schedule patient appointments for telehealth or 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 using Telehealth platform 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.

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Overview

The Associate Vice President of Call Center Operations plays a critical role in managing and optimizing call center operations, with a focus on supporting Medicare-related services. As an AVP, you'll lead a team responsible for delivering exceptional customer service to Medicare beneficiaries.

Responsibilities:

Strategic Leadership

• Develop and execute strategies to enhance call center performance, ensuring efficient handling of Medicare inquiries, claims, and member services.

• Collaborate with cross-functional teams to align call center operations with Medicare compliance and quality standards.

Operational Excellence

• Oversee day-to-day call center activities, including call volume management, workforce planning, and performance metrics.

• Implement best practices to improve efficiency, accuracy, and member satisfaction.

• Responsible for ensuring teams deliver effective customer service for all service needs including benefits, claims, billing inquiries, service requests, suggestions, and complaints.

• Directly and through team members resolves both member and provider inquiries and complaints fairly and effectively.

• Provides direction and coordination to deliver accurate product and service information to members and providers and identifies opportunities to increase membership by improving our member and provider experience.

• Recommends and implements programs to support member and provider needs. Works within a matrix environment with dotted line relationships across multiple lines of business.

• Ensure leaders and staff are working on retention and expansion initiatives.

• Ensure compliance with Medicare guidelines and regulations.

• Drives and maintains relationships with all contact center vendors to drive performance excellence. Provides leadership and oversight of all call center vendors, including ensuring all outsourced call center vendors meet all key performance indicators and contractual requirements.

Quality Assurance

• Monitor call center interactions to maintain high-quality service.

• Implement quality control processes and provide feedback to agents.

• Address escalated issues promptly.

Technology and Process Improvement:

• Evaluate call center technologies and tools to enhance productivity and member experience.

• Identify process bottlenecks and recommend improvements.

Stakeholder Collaboration:

• Work closely with Medicare program managers, compliance officers, and other relevant stakeholders.

• Provide regular updates on call center performance and initiatives.

Job Qualifications

Education : Bachelor's degree (advanced degrees preferred).

10 years of experience:

• Proven leadership experience in healthcare operations, preferably call center operations within the Medicare and MMP domain. Experience preferred with dual eligible (Medicare-Medicaid) population.

• Familiarity with Medicare regulations, policies, and procedures.

• Strong analytical skills and ability to drive process improvements.

• Excellent communication and collaboration skills.

• Previous experience managing staff, including hiring, training, managing workload and performance.

• Experience in managing a large-scale call center with remote staffing preferred.

• Experience in improving CTM performance and impact, as well as driving Customer Satisfaction (NPS) Improvement.

#PJCC

#LI-AC1

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: $140,795 - $274,550.26 / 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's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information.

Job Duties

- Evaluates credentialing applications for accuracy and completeness based on differences in provider specialty and obtains required verifications as outlined in Molina policies/procedures and regulatory requirements, while meeting production goals.

- Communicates with health care providers to clarify questions and request any missing information.

- Updates credentialing software systems with required information.

- Requests recredentialing applications from providers and conducts follow-up on application requests, following department guidelines and production goals.

- Collaborates with internal and external contacts to ensure timely processing or termination of recredentialing applicants.

- Completes data corrections in the credentialing database necessary for processing of recredentialing applications.

- Reviews claims payment systems to determine provider status, as necessary.

- Completes follow-up for provider files on 'watch' status, as necessary, following department guidelines and production goals.

- Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions.

- Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare.

- Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found.

JOB QUALIFICATIONS

Required Education:

High School Diploma or GED.

Required Experience/Knowledge Skills & Abilities

- Experience in a production or administrative role requiring self-direction and critical thinking.

- Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems.

- Experience with professional written and verbal communication.

Preferred Experience:

Experience in the health care industry

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

#PJHPO

Pay Range: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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 telehealth or 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 using Telehealth platform 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.

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information.

Job Duties

- Evaluates credentialing applications for accuracy and completeness based on differences in provider specialty and obtains required verifications as outlined in Molina policies/procedures and regulatory requirements, while meeting production goals.

- Communicates with health care providers to clarify questions and request any missing information.

- Updates credentialing software systems with required information.

- Requests recredentialing applications from providers and conducts follow-up on application requests, following department guidelines and production goals.

- Collaborates with internal and external contacts to ensure timely processing or termination of recredentialing applicants.

- Completes data corrections in the credentialing database necessary for processing of recredentialing applications.

- Reviews claims payment systems to determine provider status, as necessary.

- Completes follow-up for provider files on 'watch' status, as necessary, following department guidelines and production goals.

- Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions.

- Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare.

- Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found.

JOB QUALIFICATIONS

Required Education:

High School Diploma or GED.

Required Experience/Knowledge Skills & Abilities

- Experience in a production or administrative role requiring self-direction and critical thinking.

- Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems.

- Experience with professional written and verbal communication.

Preferred Experience:

Experience in the health care industry

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

#PJHPO

Pay Range: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information.

Job Duties

- Evaluates credentialing applications for accuracy and completeness based on differences in provider specialty and obtains required verifications as outlined in Molina policies/procedures and regulatory requirements, while meeting production goals.

- Communicates with health care providers to clarify questions and request any missing information.

- Updates credentialing software systems with required information.

- Requests recredentialing applications from providers and conducts follow-up on application requests, following department guidelines and production goals.

- Collaborates with internal and external contacts to ensure timely processing or termination of recredentialing applicants.

- Completes data corrections in the credentialing database necessary for processing of recredentialing applications.

- Reviews claims payment systems to determine provider status, as necessary.

- Completes follow-up for provider files on 'watch' status, as necessary, following department guidelines and production goals.

- Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions.

- Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare.

- Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found.

JOB QUALIFICATIONS

Required Education:

High School Diploma or GED.

Required Experience/Knowledge Skills & Abilities

- Experience in a production or administrative role requiring self-direction and critical thinking.

- Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems.

- Experience with professional written and verbal communication.

Preferred Experience:

Experience in the health care industry

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

#PJHPO

Pay Range: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Overview

The Associate Vice President of Call Center Operations plays a critical role in managing and optimizing call center operations, with a focus on supporting Medicare-related services. As an AVP, you'll lead a team responsible for delivering exceptional customer service to Medicare beneficiaries.

Responsibilities:

Strategic Leadership

• Develop and execute strategies to enhance call center performance, ensuring efficient handling of Medicare inquiries, claims, and member services.

• Collaborate with cross-functional teams to align call center operations with Medicare compliance and quality standards.

Operational Excellence

• Oversee day-to-day call center activities, including call volume management, workforce planning, and performance metrics.

• Implement best practices to improve efficiency, accuracy, and member satisfaction.

• Responsible for ensuring teams deliver effective customer service for all service needs including benefits, claims, billing inquiries, service requests, suggestions, and complaints.

• Directly and through team members resolves both member and provider inquiries and complaints fairly and effectively.

• Provides direction and coordination to deliver accurate product and service information to members and providers and identifies opportunities to increase membership by improving our member and provider experience.

• Recommends and implements programs to support member and provider needs. Works within a matrix environment with dotted line relationships across multiple lines of business.

• Ensure leaders and staff are working on retention and expansion initiatives.

• Ensure compliance with Medicare guidelines and regulations.

• Drives and maintains relationships with all contact center vendors to drive performance excellence. Provides leadership and oversight of all call center vendors, including ensuring all outsourced call center vendors meet all key performance indicators and contractual requirements.

Quality Assurance

• Monitor call center interactions to maintain high-quality service.

• Implement quality control processes and provide feedback to agents.

• Address escalated issues promptly.

Technology and Process Improvement:

• Evaluate call center technologies and tools to enhance productivity and member experience.

• Identify process bottlenecks and recommend improvements.

Stakeholder Collaboration:

• Work closely with Medicare program managers, compliance officers, and other relevant stakeholders.

• Provide regular updates on call center performance and initiatives.

Job Qualifications

Education : Bachelor's degree (advanced degrees preferred).

10 years of experience:

• Proven leadership experience in healthcare operations, preferably call center operations within the Medicare and MMP domain. Experience preferred with dual eligible (Medicare-Medicaid) population.

• Familiarity with Medicare regulations, policies, and procedures.

• Strong analytical skills and ability to drive process improvements.

• Excellent communication and collaboration skills.

• Previous experience managing staff, including hiring, training, managing workload and performance.

• Experience in managing a large-scale call center with remote staffing preferred.

• Experience in improving CTM performance and impact, as well as driving Customer Satisfaction (NPS) Improvement.

#PJCC

#LI-AC1

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: $140,795 - $274,550.26 / 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 Overview

The Associate Vice President of Call Center Operations plays a critical role in managing and optimizing call center operations, with a focus on supporting Medicare-related services. As an AVP, you'll lead a team responsible for delivering exceptional customer service to Medicare beneficiaries.

Responsibilities:

Strategic Leadership

• Develop and execute strategies to enhance call center performance, ensuring efficient handling of Medicare inquiries, claims, and member services.

• Collaborate with cross-functional teams to align call center operations with Medicare compliance and quality standards.

Operational Excellence

• Oversee day-to-day call center activities, including call volume management, workforce planning, and performance metrics.

• Implement best practices to improve efficiency, accuracy, and member satisfaction.

• Responsible for ensuring teams deliver effective customer service for all service needs including benefits, claims, billing inquiries, service requests, suggestions, and complaints.

• Directly and through team members resolves both member and provider inquiries and complaints fairly and effectively.

• Provides direction and coordination to deliver accurate product and service information to members and providers and identifies opportunities to increase membership by improving our member and provider experience.

• Recommends and implements programs to support member and provider needs. Works within a matrix environment with dotted line relationships across multiple lines of business.

• Ensure leaders and staff are working on retention and expansion initiatives.

• Ensure compliance with Medicare guidelines and regulations.

• Drives and maintains relationships with all contact center vendors to drive performance excellence. Provides leadership and oversight of all call center vendors, including ensuring all outsourced call center vendors meet all key performance indicators and contractual requirements.

Quality Assurance

• Monitor call center interactions to maintain high-quality service.

• Implement quality control processes and provide feedback to agents.

• Address escalated issues promptly.

Technology and Process Improvement:

• Evaluate call center technologies and tools to enhance productivity and member experience.

• Identify process bottlenecks and recommend improvements.

Stakeholder Collaboration:

• Work closely with Medicare program managers, compliance officers, and other relevant stakeholders.

• Provide regular updates on call center performance and initiatives.

Job Qualifications

Education : Bachelor's degree (advanced degrees preferred).

10 years of experience:

• Proven leadership experience in healthcare operations, preferably call center operations within the Medicare and MMP domain. Experience preferred with dual eligible (Medicare-Medicaid) population.

• Familiarity with Medicare regulations, policies, and procedures.

• Strong analytical skills and ability to drive process improvements.

• Excellent communication and collaboration skills.

• Previous experience managing staff, including hiring, training, managing workload and performance.

• Experience in managing a large-scale call center with remote staffing preferred.

• Experience in improving CTM performance and impact, as well as driving Customer Satisfaction (NPS) Improvement.

#PJCC

#LI-AC1

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: $140,795 - $274,550.26 / ANNUAL

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

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

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

Job Duties

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

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

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

• Establish and document reasonable medical diagnoses

• Seek specialty consultation as appropriate

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

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

• Create and implements a medical plan of care

• Schedule patient appointments for telehealth or 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 using Telehealth platform 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.

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