Company Detail

Job Description

Candidates must live in SAN DIEGO COUNTY in the state of California for consideration.

Community Connectors will work in remote and field settings our Medicaid Population. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Excellent skillset working with EMR's and Microsoft Office.

Travel is required to do member visits in the surrounding areas. Travel will be within a 1- 2 hour radius in the county that you live in. A clean DMV driving record, proof of auto insurance, and reliable transportation is required. Must be able to do your own driving. Please consider this requirement before you apply to this role.

Home office with internet connectivity of high speed required. You must provide your own home office including desk and chair.

Schedule: Monday thru Friday 8:30AM to 5:30PM Pacific.

BILINGUAL SPANISH PREFERRED

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

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

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

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

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

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

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

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

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

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

HS Diploma/GED

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

PREFERRED EDUCATION:

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

PREFERRED EXPERIENCE:

- Bilingual based on community need.

- Familiarity with healthcare systems a plus.

- Knowledge of community-specific culture.

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

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

- Active and unrestricted Medical Assistant Certification

STATE SPECIFIC REQUIREMENTS: OHIO

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

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

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

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

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

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

Pay Range: $14.76 - $31.97 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

TMG is on the lookout for our next great Eligibility Screener! If you love doing meaningful work that helps others live their best lives, we want to hear from you!

We're currently in search for someone with a background in human services, social work, healthcare or case management to join our team. This is a remote position, where you will partner with people in your community who use the TMG IRIS Consultant Agency. While this role is home-based, you will spend most days visiting IRIS participants in their homes. While you'll have a routine for the work that you do, no two days are alike!

As an Eligibility Screener, you would be responsible for completing the Adult Long-Term Care Functional Screens (LTC-FS) for participants of the Wisconsin IRIS program - a Medicaid long-term care option for older adults and people with disabilities. The job includes completing annual rescreens and any change-in-condition screens using the Adult LTC-FS tool to ensure program eligibility. Successful candidates will be approachable, compassionate and respectful of people of all different backgrounds and abilities, and be able to see and articulate the strengths that people inherently have.

TMG is committed to maintaining a diverse and inclusive workforce, and prioritizes helping staff have a good work/life balance. Even though the position is remote, you'll have lots of support from your TMG team and coworkers across the organization. If this sounds like the job for you, apply today!

Job Duties

• Meets with IRIS participants face to face to complete the screening process.

• Completes the Adult Long Term Care Functional Screen (LTC-FS) for people in IRIS according to the Wisconsin Adult LTC-FS Instructions.

• Completes contacts to verify screen results with IRIS Consultants, Medicaid Personal Care agencies, and verifies diagnosis information with physicians and the Social Security Administration, when needed.

• Meets the highest standards of documentation and program regulations, while ensuring timely completion of screens.

• Maintains screening skills by participating in weekly team meetings, monthly All Screener Meetings, trainings and testing.

• Other duties as assigned by management.

Job Qualifications

REQUIRED EDUCATION :

Bachelor's Degree in a health or human services or related field. (e.g., social work, psychology) or graduate from an Accredited School of Nursing.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

• 1+ years of experience working with one of the target groups such as adults with physical or intellectual disabilities or older adults.

• Strong written and verbal communication skills; strong attention to detail.

• Demonstrated computer and software skills required; proficiency with Microsoft Office Suite and other software.

• Strong customer service skills.

• Good organizational and time management skills.

• The ability to work cooperatively as part of a team or autonomously

• Ability to remain flexible in the work environment and willing and able to adapt to changing organizational needs.

• Travel Requirements 5%

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION :

• Must pass the Wisconsin Adult Long-term Care Functional Screen certification modules (80% or higher on each module) within first week of hire and maintain certification as a screener.

• If a graduate from an Accredited School of Nursing, must have an active, unrestricted Wisconsin Registered Nursing (RN) license in good standing

• Must possess a valid driver's license, maintain adequate auto insurance for job-related travel and ability to travel throughout Wisconsin or other

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :

Currently or formerly certified in the Long-Term Care Functional Screen.

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: $19.84 - $38.69 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB TITLE TRANSITION OF CARE COACH

Candidates must live in SAN DIEGO COUNTY in the state of California for consideration.

TOC Coaches will work in remote and field settings our Medicaid Population. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Excellent skillset working with EMR's and Microsoft Office.

Travel is required to do member visits in the surrounding areas. Travel will be within a 1- 2 hour radius in the county that you live in. A clean DMV driving record, proof of auto insurance, and reliable transportation is required. Must be able to do your own driving. Please consider this requirement before you apply to this role.

Home office with internet connectivity of high speed required. You must provide your own home office including desk and chair.

Schedule: Monday thru Friday 8:30AM to 5:30PM Pacific.

BILINGUAL SPANISH nice to have but not required. ECM experience very helpful.

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

• Follows member throughout a 30-day program that starts at hospital admission and continues its oversight through transitions from the acute setting to all other settings, including nursing facility placement and private home, with the goal of reduced readmissions.

• Ensures safe and appropriate transitions by collaborating with the hospital discharge planner, as well as collaborating as needed or at the request of the member with hospitalists, outpatient providers, facility staff, and family/support network.

• Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required. Works with participating ancillary providers (LTSS/HCSS, DME), public agencies or other identified service providers to make sure necessary services and equipment are in place for a safe transition.

• Conducts face-to-face visits of all members while in the hospital; home visits of high-risk members post discharge.

• 40-50% local travel required.

• Coordinates care and reassesses member's needs using the 2-day, 7-day and 14-day post-discharge timeline recommended by the Coleman Care Transitions Model.

• Educates and supports member focusing on seven primary areas (ToC Pillars): medication management, use of personal health record, follow up care, signs and symptoms of worsening condition, nutrition, functional needs and or Home and Community-based Services, and advance directives.

• 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.

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

• ToC Coaches in Behavioral Health and Social Science fields may provide consultation, resources and recommendations to peers as needed.

JOB QUALIFICATIONS

Required Education

Any of the following:

• Completion of an accredited Licensed Vocational Nurse (LVN)

• Licensed Practical Nurse (LPN) Program

• Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work.

Required Experience

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

• Knowledge of or experience using the Care Transitions Intervention or similar model; background in discharge planning and/or home health.

Required License, Certification, Association

• If required by applicable State, an LVN/LPN license in good standing.

• Otherwise, If licensed, license must be active, unrestricted and in good standing.

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

Preferred Experience

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

Preferred License, Certification, Association

Any of the following:

• Transitions of Care Sub-Specialty Certification

• Licensed Clinical Social Worker (LCSW)

• Advanced Practice Social Worker (APSW)

• Certified Case Manager (CCM)

• Certified in Health Education and Promotion (CHEP)

• Licensed Professional Counselor (LPC/LPCC)

• Respiratory Therapist

• Licensed Marriage and Family Therapist (LMFT)

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

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

Pay Range: $21.6 - $46.81 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

TMG is on the lookout for our next great Eligibility Screener! If you love doing meaningful work that helps others live their best lives, we want to hear from you!

We're currently in search for someone with a background in human services, social work, healthcare or case management to join our team. This is a remote position, where you will partner with people in your community who use the TMG IRIS Consultant Agency. While this role is home-based, you will spend most days visiting IRIS participants in their homes. While you'll have a routine for the work that you do, no two days are alike!

As an Eligibility Screener, you would be responsible for completing the Adult Long-Term Care Functional Screens (LTC-FS) for participants of the Wisconsin IRIS program - a Medicaid long-term care option for older adults and people with disabilities. The job includes completing annual rescreens and any change-in-condition screens using the Adult LTC-FS tool to ensure program eligibility. Successful candidates will be approachable, compassionate and respectful of people of all different backgrounds and abilities, and be able to see and articulate the strengths that people inherently have.

TMG is committed to maintaining a diverse and inclusive workforce, and prioritizes helping staff have a good work/life balance. Even though the position is remote, you'll have lots of support from your TMG team and coworkers across the organization. If this sounds like the job for you, apply today!

Job Duties

• Meets with IRIS participants face to face to complete the screening process.

• Completes the Adult Long Term Care Functional Screen (LTC-FS) for people in IRIS according to the Wisconsin Adult LTC-FS Instructions.

• Completes contacts to verify screen results with IRIS Consultants, Medicaid Personal Care agencies, and verifies diagnosis information with physicians and the Social Security Administration, when needed.

• Meets the highest standards of documentation and program regulations, while ensuring timely completion of screens.

• Maintains screening skills by participating in weekly team meetings, monthly All Screener Meetings, trainings and testing.

• Other duties as assigned by management.

Job Qualifications

REQUIRED EDUCATION :

Bachelor's Degree in a health or human services or related field. (e.g., social work, psychology) or graduate from an Accredited School of Nursing.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

• 1+ years of experience working with one of the target groups such as adults with physical or intellectual disabilities or older adults.

• Strong written and verbal communication skills; strong attention to detail.

• Demonstrated computer and software skills required; proficiency with Microsoft Office Suite and other software.

• Strong customer service skills.

• Good organizational and time management skills.

• The ability to work cooperatively as part of a team or autonomously

• Ability to remain flexible in the work environment and willing and able to adapt to changing organizational needs.

• Travel Requirements 5%

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION :

• Must pass the Wisconsin Adult Long-term Care Functional Screen certification modules (80% or higher on each module) within first week of hire and maintain certification as a screener.

• If a graduate from an Accredited School of Nursing, must have an active, unrestricted Wisconsin Registered Nursing (RN) license in good standing

• Must possess a valid driver's license, maintain adequate auto insurance for job-related travel and ability to travel throughout Wisconsin or other

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :

Currently or formerly certified in the Long-Term Care Functional Screen.

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: $19.84 - $38.69 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Candidates must live in SAN DIEGO COUNTY in the state of California for consideration.

Community Connectors will work in remote and field settings our Medicaid Population. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Excellent skillset working with EMR's and Microsoft Office.

Travel is required to do member visits in the surrounding areas. Travel will be within a 1- 2 hour radius in the county that you live in. A clean DMV driving record, proof of auto insurance, and reliable transportation is required. Must be able to do your own driving. Please consider this requirement before you apply to this role.

Home office with internet connectivity of high speed required. You must provide your own home office including desk and chair.

Schedule: Monday thru Friday 8:30AM to 5:30PM Pacific.

BILINGUAL SPANISH PREFERRED

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

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

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

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

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

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

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

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

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

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

HS Diploma/GED

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

PREFERRED EDUCATION:

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

PREFERRED EXPERIENCE:

- Bilingual based on community need.

- Familiarity with healthcare systems a plus.

- Knowledge of community-specific culture.

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

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

- Active and unrestricted Medical Assistant Certification

STATE SPECIFIC REQUIREMENTS: OHIO

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

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

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

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

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

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

Pay Range: $14.76 - $31.97 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB TITLE TRANSITION OF CARE COACH

Candidates must live in SAN DIEGO COUNTY in the state of California for consideration.

TOC Coaches will work in remote and field settings our Medicaid Population. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Excellent skillset working with EMR's and Microsoft Office.

Travel is required to do member visits in the surrounding areas. Travel will be within a 1- 2 hour radius in the county that you live in. A clean DMV driving record, proof of auto insurance, and reliable transportation is required. Must be able to do your own driving. Please consider this requirement before you apply to this role.

Home office with internet connectivity of high speed required. You must provide your own home office including desk and chair.

Schedule: Monday thru Friday 8:30AM to 5:30PM Pacific.

BILINGUAL SPANISH nice to have but not required. ECM experience very helpful.

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

• Follows member throughout a 30-day program that starts at hospital admission and continues its oversight through transitions from the acute setting to all other settings, including nursing facility placement and private home, with the goal of reduced readmissions.

• Ensures safe and appropriate transitions by collaborating with the hospital discharge planner, as well as collaborating as needed or at the request of the member with hospitalists, outpatient providers, facility staff, and family/support network.

• Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required. Works with participating ancillary providers (LTSS/HCSS, DME), public agencies or other identified service providers to make sure necessary services and equipment are in place for a safe transition.

• Conducts face-to-face visits of all members while in the hospital; home visits of high-risk members post discharge.

• 40-50% local travel required.

• Coordinates care and reassesses member's needs using the 2-day, 7-day and 14-day post-discharge timeline recommended by the Coleman Care Transitions Model.

• Educates and supports member focusing on seven primary areas (ToC Pillars): medication management, use of personal health record, follow up care, signs and symptoms of worsening condition, nutrition, functional needs and or Home and Community-based Services, and advance directives.

• 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.

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

• ToC Coaches in Behavioral Health and Social Science fields may provide consultation, resources and recommendations to peers as needed.

JOB QUALIFICATIONS

Required Education

Any of the following:

• Completion of an accredited Licensed Vocational Nurse (LVN)

• Licensed Practical Nurse (LPN) Program

• Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work.

Required Experience

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

• Knowledge of or experience using the Care Transitions Intervention or similar model; background in discharge planning and/or home health.

Required License, Certification, Association

• If required by applicable State, an LVN/LPN license in good standing.

• Otherwise, If licensed, license must be active, unrestricted and in good standing.

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

Preferred Experience

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

Preferred License, Certification, Association

Any of the following:

• Transitions of Care Sub-Specialty Certification

• Licensed Clinical Social Worker (LCSW)

• Advanced Practice Social Worker (APSW)

• Certified Case Manager (CCM)

• Certified in Health Education and Promotion (CHEP)

• Licensed Professional Counselor (LPC/LPCC)

• Respiratory Therapist

• Licensed Marriage and Family Therapist (LMFT)

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

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

Pay Range: $21.6 - $46.81 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina of New Mexico is hiring for a Sr. Growth & Community Engagement Specialist in Southwest New Mexico. Highly preferred counties are Dona Ana, Chaves, and/or Eddy.

Responsibilities include, but are not limited to supporting growth, retention, member and community engagement, along with Resource Center activities. This role will be tasked with developing and establishing strong community partnerships that support Molina's growth and member experience goals.

This role is looking for someone who has been in a field-based, community/public facing role previously. This could be in many capacities, including but not limited to the following: Health Educator, Liaison, Promoter, Outreach Worker, Patient Navigator, Health Interpreter, Public Health Aide, Connector, Sales, Marketing, Insurance Agent, Insurance Consultant, etc....

This role is community/ external facing and is in frequent engagement with providers (clinics, hospitals, community health centers), community-based organizations/ nonprofits such as those working in housing/ food/ behavioral health and many more. Top notch communication and relationship building skills are essential.

This role is in the field 50-70+ percent of the time , meeting with partners and attending/ hosting community events. The intent of the position is to help retain and grow our Molina membership. There may be events that are outside of normal business hours (evenings or a weekend day). You would flex other time off to ensure to have a healthy work/life balance.

Bilingual- English/Spanish highly desired.

KNOWLEDGE/SKILLS/ABILITIES

• Responsible for achieving established goals improving Molina's enrollment growth objectives, with primary responsibility for Medicaid. Works collaboratively with key departments across the enterprise to improve overall choice rates and assignment percentages.

• Under limited supervision, responsible for carrying out enrollment events and achieving assigned membership growth targets through a combination of direct and indirect marketing activities, with the primary responsibility of improving the plan's overall -choice- rate. Works collaboratively with other key departments to increase Medicaid assignment percentage for Molina.

• Provides leadership for new or less experienced Enrollment Growth team members by training, developing, coaching, mentoring and being a positive role model. May also serve as the Acting Supervisor or Manager for the team upon management request.

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

• Works closely with other team members and management to develop/maintain/deepen relationships with key business leaders, community-based organizations (CBOs) and providers, ensuring all efforts are directed towards building Medicaid membership. Effectively moves these relationships through the -enrollment- pipeline.

• Schedules, coordinates & participates in enrollment events, encourages key partners to participate, and assists where feasible.

• Works cohesively with Provider Services to ensure providers within assigned territory are aware of Molina products and services. Establishes simple referral processes for providers and CBOs to refer clients who may be eligible for other Molina products.

• Viewed as a -subject matter expert- (SME) by community and influencers on the health care delivery system and wellness topics.

• Delivers presentations, attends meetings and distributes educational materials to both members and potential members.

• Answers incoming calls from perspective and current members. Provides them with information and materials about Molina Healthcare. Directs members to the appropriate Molina department(s) as needed and assists with contacting department(s) through in-house phone line assistance.

• Coordinates, leads, and executes company programs for each of their perspective regions.

• Responsible for assisting and executing Molina turnkey events and align media components.

• Trains all new Specialist team members and serve as a mentor and resource for existing Specialist team members.

JOB QUALIFICATIONS

REQUIRED EDUCATION: Bachelor's Degree or equivalent, job-related experience.

PREFERRED EDUCATION: Bachelor's Degree in Marketing or related discipline.

REQUIRED EXPERIENCE:

• 5 years of related experience (e.g., marketing, business development, community engagement, healthcare industry).

• Demonstrated exceptional networking and negotiations skills. Experience with sales and marketing techniques.

• Demonstrated strong public speaking and presentations skills.

• Demonstrated ability to work in a fast-paced, team-oriented environment with little supervision.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

PREFERRED EXPERIENCE:

• Prior related work experience in a senior or lead capacity.

• Solid understanding of Health Care Markets, primarily Medicaid.

• Previous healthcare marketing, enrollment and/or grassroots/community outreach experience a plus.

• 5+ years of outreach experience serving low-income populations and/or experience presenting to influencer audiences.

• 3 - 5 years project management experience, preferably in a health care or outreach setting.

• Fluency in a second language highly desirable.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

• Active Life & Health Insurance

• Market Place Certified

#PJHPO

#LI-BEMORE

#LI-TR1

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: Sales, Finance, insurance, agency, health insurance, Medicaid, Medicare, Managed care, health, healthcare, health care, advisor, enroller, ACA, enroll, enrollment, consultant, AHIP, certified, marketing, account management, insurance producer license, insurance producer, licensed agent, health insurance license, communications, Medicaid, Medicare, Long Term Care, LTC, LTSS, eligibility, health coach, community health advisor, family advocate, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter and public health aide, connector, navigator, pomodoro, healthcare, community, public relations, public health, care manager, social worker, counselor, housing coordinator, support worker, specialist, educator, government program, health and human services, community worker certification, Spanish, Bilingual

Pay Range: $17.85 - $38.69 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Candidates must have current CALIFORNIA licensure to be considered for this position.

Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Excellent skillset working with EMR's and Microsoft Office.

Home office with internet connectivity of high speed required. You must provide your own home office including desk and chair.

Work Schedule: Monday thru Friday 8:30AM to 5:30PM Pacific. Candidates who do not live in California must be willing to work Pacific CA hours.

KNOWLEDGE/SKILLS/ABILITIES

• Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM) and monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system and process audits, as needed.

• Audits for clinical gaps in care from a medical and/or behavioral perspective to ensure member needs are being met.

• Assesses clinical staff regarding appropriate clinical decision-making.

• Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings leadership.

• Ensures auditing approaches follow a Molina standard in approach and tool use.

• Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and professionalism with all communications.

• Adheres to departmental standards, policies, protocols.

• Maintains detailed records of auditing results.

• Assists HCS training team with developing training materials or job aids as needed to address findings in audit results.

• Meets minimum production standards

• May conduct staff trainings as needed

• Communicates with QA supervisor/manager about issues identified and works collaboratively to resolve/correct them.

• 15% travel required.

JOB QUALIFICATIONS

Required Education

Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program and/or Associate's or bachelor's degree in Health related field.

Required Experience

• Minimum two years UM, CM, MAT, HM, DM, and/or managed care experience.

• Proficient knowledge of Molina workflows.

Required License, Certification, Association

• Active, unrestricted State Licensed Vocational Nurse or Practical Nurse (LVN or LPN) 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 Experience

More than one-year managed care experience. One year of UM, CM, DM auditing experience.

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

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

Pay Range: $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

Family Care with My Choice Wisconsin

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

• May implement specific Molina wellness programs i.e. asthma and depression disease management.

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

• Collaborates with RN case managers/supervisors as needed or required

• Case managers in Behavioral Health and Social Science fields may provide consultation, resources and recommendations to peers as needed

• Local travel of up to 40% may be required, depending on the complexity level of the assigned members, particular state-specific regulations, or whether the Case Manager position is located within Molina's Central Programs unit.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Any of the following:

Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or Master's Degree (preferably in a social science, psychology, gerontology, public health or social work or related

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

If license required for the job, license must be active, unrestricted and in good standing.

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

STATE SPECIFIC REQUIREMENTS:

Roles serving Family Care and Family Care Partnership in the State of Wisconsin are required to have a Bachelor's Degree and a minimum of one year of professional experience.

PREFERRED EXPERIENCE:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Any of the following:

Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Case Manager (CCM), Certified in Health Education and Promotion (CHEP), Licensed Professional Counselor (LPC/LPCC), Respiratory Therapist, or Licensed Marriage and Family Therapist (LMFT).

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

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

Pay Range: $21.6 - $46.81 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Family Care with My Choice Wisconsin

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

• May implement specific Molina wellness programs i.e. asthma and depression disease management.

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

• Collaborates with RN case managers/supervisors as needed or required

• Case managers in Behavioral Health and Social Science fields may provide consultation, resources and recommendations to peers as needed

• Local travel of up to 40% may be required, depending on the complexity level of the assigned members, particular state-specific regulations, or whether the Case Manager position is located within Molina's Central Programs unit.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Any of the following:

Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or Master's Degree (preferably in a social science, psychology, gerontology, public health or social work or related

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

If license required for the job, license must be active, unrestricted and in good standing.

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

STATE SPECIFIC REQUIREMENTS:

Roles serving Family Care and Family Care Partnership in the State of Wisconsin are required to have a Bachelor's Degree and a minimum of one year of professional experience.

PREFERRED EXPERIENCE:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Any of the following:

Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Case Manager (CCM), Certified in Health Education and Promotion (CHEP), Licensed Professional Counselor (LPC/LPCC), Respiratory Therapist, or Licensed Marriage and Family Therapist (LMFT).

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

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

Pay Range: $21.6 - $46.81 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Family Care with My Choice Wisconsin

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

• May implement specific Molina wellness programs i.e. asthma and depression disease management.

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

• Collaborates with RN case managers/supervisors as needed or required

• Case managers in Behavioral Health and Social Science fields may provide consultation, resources and recommendations to peers as needed

• Local travel of up to 40% may be required, depending on the complexity level of the assigned members, particular state-specific regulations, or whether the Case Manager position is located within Molina's Central Programs unit.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Any of the following:

Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or Master's Degree (preferably in a social science, psychology, gerontology, public health or social work or related

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

If license required for the job, license must be active, unrestricted and in good standing.

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

STATE SPECIFIC REQUIREMENTS:

Roles serving Family Care and Family Care Partnership in the State of Wisconsin are required to have a Bachelor's Degree and a minimum of one year of professional experience.

PREFERRED EXPERIENCE:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Any of the following:

Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Case Manager (CCM), Certified in Health Education and Promotion (CHEP), Licensed Professional Counselor (LPC/LPCC), Respiratory Therapist, or Licensed Marriage and Family Therapist (LMFT).

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

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

Pay Range: $21.6 - $46.81 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

We have an extensive training program for new Grads!

Molina Student Loan Payment program available to Nurse Practitioners

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

We have an extensive training program for new Grads!

Molina Student Loan Payment program available to Nurse Practitioners

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

Candidates must have current CALIFORNIA licensure to be considered for this position.

Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Excellent skillset working with EMR's and Microsoft Office.

Home office with internet connectivity of high speed required. You must provide your own home office including desk and chair.

Work Schedule: Monday thru Friday 8:30AM to 5:30PM Pacific. Candidates who do not live in California must be willing to work Pacific CA hours.

KNOWLEDGE/SKILLS/ABILITIES

• Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM) and monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system and process audits, as needed.

• Audits for clinical gaps in care from a medical and/or behavioral perspective to ensure member needs are being met.

• Assesses clinical staff regarding appropriate clinical decision-making.

• Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings leadership.

• Ensures auditing approaches follow a Molina standard in approach and tool use.

• Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and professionalism with all communications.

• Adheres to departmental standards, policies, protocols.

• Maintains detailed records of auditing results.

• Assists HCS training team with developing training materials or job aids as needed to address findings in audit results.

• Meets minimum production standards

• May conduct staff trainings as needed

• Communicates with QA supervisor/manager about issues identified and works collaboratively to resolve/correct them.

• 15% travel required.

JOB QUALIFICATIONS

Required Education

Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program and/or Associate's or bachelor's degree in Health related field.

Required Experience

• Minimum two years UM, CM, MAT, HM, DM, and/or managed care experience.

• Proficient knowledge of Molina workflows.

Required License, Certification, Association

• Active, unrestricted State Licensed Vocational Nurse or Practical Nurse (LVN or LPN) 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 Experience

More than one-year managed care experience. One year of UM, CM, DM auditing experience.

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

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

Pay Range: $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

We have an extensive training program for new Grads!

Molina Student Loan Payment program available to Nurse Practitioners

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

Candidates must live in SAN BERNARDINO OR RIVERSIDE COUNTY in the state of California for consideration.

Community Connectors will work in remote and field settings our Medicaid Population. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Excellent skillset working with EMR's and Microsoft Office.

Travel is required to do member visits in the surrounding areas. Travel will be within a 1- 2 hour radius in the county that you live in. A clean DMV driving record, proof of auto insurance, and reliable transportation is required. Must be able to do your own driving. Please consider this requirement before you apply to this role.

Home office with internet connectivity of high speed required. You must provide your own home office including desk and chair.

Schedule: Monday thru Friday 8:30AM to 5:30PM Pacific.

BILINGUAL SPANISH PREFERRED

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

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

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

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

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

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

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

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

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

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

HS Diploma/GED

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

PREFERRED EDUCATION:

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

PREFERRED EXPERIENCE:

- Bilingual based on community need.

- Familiarity with healthcare systems a plus.

- Knowledge of community-specific culture.

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

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

- Active and unrestricted Medical Assistant Certification

STATE SPECIFIC REQUIREMENTS: OHIO

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

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

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

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

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

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

Pay Range: $14.76 - $31.97 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina of New Mexico is hiring for a Sr. Growth & Community Engagement Specialist in Southwest New Mexico. Highly preferred counties are Dona Ana, Chaves, and/or Eddy.

Responsibilities include, but are not limited to supporting growth, retention, member and community engagement, along with Resource Center activities. This role will be tasked with developing and establishing strong community partnerships that support Molina's growth and member experience goals.

This role is looking for someone who has been in a field-based, community/public facing role previously. This could be in many capacities, including but not limited to the following: Health Educator, Liaison, Promoter, Outreach Worker, Patient Navigator, Health Interpreter, Public Health Aide, Connector, Sales, Marketing, Insurance Agent, Insurance Consultant, etc....

This role is community/ external facing and is in frequent engagement with providers (clinics, hospitals, community health centers), community-based organizations/ nonprofits such as those working in housing/ food/ behavioral health and many more. Top notch communication and relationship building skills are essential.

This role is in the field 50-70+ percent of the time , meeting with partners and attending/ hosting community events. The intent of the position is to help retain and grow our Molina membership. There may be events that are outside of normal business hours (evenings or a weekend day). You would flex other time off to ensure to have a healthy work/life balance.

Bilingual- English/Spanish highly desired.

KNOWLEDGE/SKILLS/ABILITIES

• Responsible for achieving established goals improving Molina's enrollment growth objectives, with primary responsibility for Medicaid. Works collaboratively with key departments across the enterprise to improve overall choice rates and assignment percentages.

• Under limited supervision, responsible for carrying out enrollment events and achieving assigned membership growth targets through a combination of direct and indirect marketing activities, with the primary responsibility of improving the plan's overall -choice- rate. Works collaboratively with other key departments to increase Medicaid assignment percentage for Molina.

• Provides leadership for new or less experienced Enrollment Growth team members by training, developing, coaching, mentoring and being a positive role model. May also serve as the Acting Supervisor or Manager for the team upon management request.

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

• Works closely with other team members and management to develop/maintain/deepen relationships with key business leaders, community-based organizations (CBOs) and providers, ensuring all efforts are directed towards building Medicaid membership. Effectively moves these relationships through the -enrollment- pipeline.

• Schedules, coordinates & participates in enrollment events, encourages key partners to participate, and assists where feasible.

• Works cohesively with Provider Services to ensure providers within assigned territory are aware of Molina products and services. Establishes simple referral processes for providers and CBOs to refer clients who may be eligible for other Molina products.

• Viewed as a -subject matter expert- (SME) by community and influencers on the health care delivery system and wellness topics.

• Delivers presentations, attends meetings and distributes educational materials to both members and potential members.

• Answers incoming calls from perspective and current members. Provides them with information and materials about Molina Healthcare. Directs members to the appropriate Molina department(s) as needed and assists with contacting department(s) through in-house phone line assistance.

• Coordinates, leads, and executes company programs for each of their perspective regions.

• Responsible for assisting and executing Molina turnkey events and align media components.

• Trains all new Specialist team members and serve as a mentor and resource for existing Specialist team members.

JOB QUALIFICATIONS

REQUIRED EDUCATION: Bachelor's Degree or equivalent, job-related experience.

PREFERRED EDUCATION: Bachelor's Degree in Marketing or related discipline.

REQUIRED EXPERIENCE:

• 5 years of related experience (e.g., marketing, business development, community engagement, healthcare industry).

• Demonstrated exceptional networking and negotiations skills. Experience with sales and marketing techniques.

• Demonstrated strong public speaking and presentations skills.

• Demonstrated ability to work in a fast-paced, team-oriented environment with little supervision.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

PREFERRED EXPERIENCE:

• Prior related work experience in a senior or lead capacity.

• Solid understanding of Health Care Markets, primarily Medicaid.

• Previous healthcare marketing, enrollment and/or grassroots/community outreach experience a plus.

• 5+ years of outreach experience serving low-income populations and/or experience presenting to influencer audiences.

• 3 - 5 years project management experience, preferably in a health care or outreach setting.

• Fluency in a second language highly desirable.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

• Active Life & Health Insurance

• Market Place Certified

#PJHPO

#LI-BEMORE

#LI-TR1

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: Sales, Finance, insurance, agency, health insurance, Medicaid, Medicare, Managed care, health, healthcare, health care, advisor, enroller, ACA, enroll, enrollment, consultant, AHIP, certified, marketing, account management, insurance producer license, insurance producer, licensed agent, health insurance license, communications, Medicaid, Medicare, Long Term Care, LTC, LTSS, eligibility, health coach, community health advisor, family advocate, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter and public health aide, connector, navigator, pomodoro, healthcare, community, public relations, public health, care manager, social worker, counselor, housing coordinator, support worker, specialist, educator, government program, health and human services, community worker certification, Spanish, Bilingual

Pay Range: $17.85 - $38.69 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

The VP, Healthcare Services is responsible for oversight and management of the state health plan's Healthcare Services (clinical operations) teams including Utilization Management (prior-authorization, inpatient review) and Care Management (case/health management and transition of care). This position works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets.

• Works with the Healthcare Services management team to achieve successful implementation of Molina clinical strategy and direction.

• Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operations functions and promote quality cost effective health care for Molina members.

• Mentors, guides, and develops skills of management team members in a consistent and effective manner.

• Develops initiatives to achieve budgeted reductions in medical expenses and increases in quality scores.

• Develops Healthcare Services department budget and ensures budget targets are met.

• Manages implementation of analytical studies that quantify the benefits of Healthcare Services programs to ensure that resources are appropriately allocated, operational controls exist, and efficiencies are maximized.

• Facilitates integration of care coordination, long term care, behavioral health, and chemical dependency programs.

• Continually refines operational processes and champions review of team processes, workflows, and activities.

• Articulates project requirements and anticipated outcomes to the Molina Project Management Office for identified projects/strategies to improve the efficiency of clinical operations teams to meet cost and quality goals.

• Accountable for ensuring compliance with contractual, accreditation and regulatory requirements for all Healthcare Services teams.

• Participates personally or assigns appropriate staff to Molina Quality Committees and external Community Committees to represent the Healthcare Services department.

• Ensures effective inter-departmental collaboration and interaction between Healthcare Services staff and other departments.

• Ensures monthly auditing of HCS staff is performed and appropriate actions and/or coaching occur.

• Responsible for oversight of clinical training activities and outcomes.

• Responsible for HCS-related delegation oversight monitoring.

JOB QUALIFICATIONS

Required Education

Master's Degree or equivalent combination of education and work experience.

Required Experience

• 10 years managed care experience with line management responsibility including clinical operations.

• Experience working within applicable state, federal, and third-party regulations.

• Operational and process improvement experience.

• Strong communication and teaming/interpersonal skills.

• Strong leadership capabilities and ability to initiate and maintain cross-team relationships.

• Demonstrated experience meeting Quality Accreditation Standards (NCQA/HEDIS/STARS).

Required License, Certification, Association

If licensed, license must be active, unrestricted and in good standing.

Preferred Education

Master's Degree in Business or Healthcare management (i.e. MBA, MHA, MPH).

Preferred Experience

Familiarity and experience in the local market desirable.

Preferred License, Certification, Association

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

• Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification

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

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

Pay Range: $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

Responsible for the strategic development and administration of contracts with State and/or Federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide health care services to low income, uninsured, and other populations.

KNOWLEDGE/SKILLS/ABILITIES

• Responsible for the administration of contracts with the State and/or Federal government for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide health care services to low-income, uninsured, and other populations.

• Serves as lead for contract knowledge and assists Plan President with various advocacy efforts in support of Plan business operations.

• Provides contracts and relationship management for State and Federal partners (Medicaid, Medicare, Insurance) and key State elected officials (Governor's Office, State legislators, and/or local government officials).

• Supervises Regulatory Submissions and Filings.

• Represents Molina at State and local meetings including those with the Medicaid Director, Director of Insurance, and other Medicaid officials. Develops strategies to advocate for best practices that demonstratively improve contract terms or facilitate business objectives.

• Identifies opportunities for strategic conversations with key stakeholders aligned with business needs (e.g., regarding duals, ABD children, and accountable care organizations (ACO's) that promote Molina approaches.

• Improves coordination/integration of acute and long-term services and supports (LTSS) for dual eligible and influences the State's implementation of the ACA provisions.

• Works with key statewide advocacy groups and provider trade associations to advocate Molina's position and business objectives and develop strategic partnerships.

• Works with Legal Affairs to assess and provide analyses for proposed changes to Medicaid, Medicare, Exchange, and other government-sponsored healthcare program contracts, governing regulations and new legislation and policy requirements.

• Oversees and monitors the implementation of new Medicaid and Medicare contractual and policy requirements, new legislation, and regulations.

• Coordinates plan's RFI responses, as well as RFA and RFP bid efforts, in collaboration with MHI Corporate Development.

• Coordinates with Director, Compliance on initiatives to improve adherence to plan policies and procedures and represents Government Contracts on Compliance Committee.

• Coordinates the establishment of and maintains MOUs for the plan's carved-out and linked services in State healthcare programs as applicable.

JOB QUALIFICATIONS

Required Education

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

Required Experience

• 5 years' experience in government programs and at least 2 years supervisory/management experience.

• Extensive knowledge of Medicaid, Medicare, Marketplace and/or other government-sponsored programs.

Preferred Education

Bachelor's or master's degree in public health, Public Policy or Business Administration.

Preferred Experience

Experience working in the managed care industry, particularly with health plans that contract with government-sponsored programs.

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: $122,430.44 - $238,739.35 / 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 Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state, and local regulations. Provider Services staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for the provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

KNOWLEDGE/SKILLS/ABILITIES

The VP, Network Strategy and Services is responsible for the development and implementation of enterprise-wide initiatives and projects to support robust provider and member engagement in support of achieving positive operational and financial outcomes.

• Responsible for the continued development and enhancement of the Provider Network Management and Operations Department including the implementation of standard processes, policies, and procedures.

• Work closely with the health plans leadership to ensure compliance with all Molina, regulatory and industry standards.

• Support and execute new health plan implementations, acquisitions, and expansions in collaboration with the Business Development Team.

• Drive positive cultural changes with focus on coaching and development.

• Plans, organizes, staffs, and coordinates activities of the Provider Network Management and Operations Department.

• Works with staff and Senior Management to develop and implement provider contracting strategies and provider service strategies to contain unit cost, improve member access and enhance Provider satisfaction enterprise wide.

• Develop a Standardized Provider Engagement -Tool Kit-, training program and deployment plan. Develop and implement approaches to determining outcomes of tools and training programs.

• Develop and oversee deployment strategy and monitoring for -Provider Profiles- and -Pay for Performance (P4P)- contracting.

• In conjunction with Provider Services and Provider Contracting leaders in the Health Plans and in collaboration with the MHI AVP of Provider Contracting identify, develop, and implement approaches for performance management of Value Based Reimbursement.

• Develop and refine -Clear Coverage- provider adoption strategies and assist in training of health plan staff as Clear Coverage is implemented in each Plan.

• Represent Provider Engagement with Stakeholder Experience, Quality and RAMP business partners to ensure we incorporate the necessary plans to achieve positive operational and financial outcomes.

• Monitor key metrics to determine Provider Engagement effectiveness and success (e.g., Provider Appeals and Grievances, Member Appeals and Grievances, CAHPs, STAR Ratings, HEDIS, HEP Completion Rates, etc.).

JOB QUALIFICATIONS

Required Education

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

Required Experience

Minimum 10+ years of management and strong leadership experience. Minimum 5 years of healthcare, managed care, provider services and call center operations experience in government sponsored programs. Excellent interpersonal and communication skills (verbal and written). Excellent leadership and managerial skills. Proven record of accomplishments in work history.

Preferred Education

Master's Degree

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: $186,201.39 - $363,092.71 / 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

Must live or near Topeka

JOB DESCRIPTION

Job Summary

Provides administrative level support to an Executive and division team members. Prioritizes management/client requests in order to meet business objectives. Supports the day-to-day administrative operations of the Executive and department.

Job Duties

• Composes routine executive correspondence

• Establishes and maintains official documents and records in appropriate files

• Responds to a broad range of inquiries

• Keeps executive's calendar up-to-date

• Makes necessary arrangements to ensure details for meetings are completed

• Conducts outside research for projects, as necessary

• Prepares recurring and special reports and presentations by gathering data, interpreting data and assembling reports using PowerPoint, Excel, etc. for executive's review and distribution

• Proofreads and edits materials

• Provides confidential administrative and clerical support to executive

• Receives, opens, sorts, reads and prioritizes executive's mail

• Schedules appointments, meetings, conferences, luncheons, hotel reservations and travel plans

• Serves as recording secretary for committee(s), scheduling meetings, distributing materials, recording and transcribing meeting minutes

JOB QUALIFICATIONS

REQUIRED EDUCATION:

High School diploma or equivalent GED

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

5-7 years office/clerical experience

3-5 years experience with Microsoft Office Suite

PREFERRED EDUCATION:

Business Related Courses

PREFERRED EXPERIENCE:

3-5 years experience in an administrative role

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: $19.64 - $42.55 / 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 achieving established goals improving Molina's enrollment growth objectives encompassing all lines of business. Works collaboratively with key departments across the enterprise to improve overall choice rates and assignment percentages.

- Reports directly to state's plan president, on a dotted line to National AVP of Enrollment Growth.to State's AVP, Growth and Community Engagement

KNOWLEDGE/SKILLS/ABILITIES

Implements strategies to achieve Molina's enrollment growth goals for a large and complex state plan for Medicaid.

- Accountable for achieving all established growth goals improving the plan's overall -choice- rate. Works collaboratively with other key departments to increase all Medicaid programs' assignment percentages for Molina.

- Implements strategy by market ensuring representative coverage, focusing on profitable growth.

- Provides leadership and oversight to field team in achieving enrollment, retention and choice percentage goals for assigned state.

- In accordance with corporate guidelines, oversees compliance of organizational polices and strategies for interaction with key providers, Community Based Organizations (CBOs), Faith Based Organizations (FBOs), School Based Organizations (SBOs) and Business Based Organizations (BBOs). Leads team in the development of these key relationships and how to move them through the enrollment pipeline.

- Oversees the development of successful and compliant lead generation, appointment scheduling, event management, enrollment, and member retention processes.

Directs, department budget and staff, including employment, pay and performance decisions; employee relations; and coaching/development of staff, etc.

- Oversees and ensures timely submission of all department policies and procedures and/or Marketing Plan to the state.

- Participates in and is a member of a strategic county, city and/or local initiative meeting representing Molina as a community influencer.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Bachelor's Degree or equivalent, job-related experience.

REQUIRED EXPERIENCE:

- 7-10 years health care sales/marketing and member retention experience.

- 5-10 years management/supervisory experience.

- New product development, positioning and start-up experience; marketing segmentation experience.

- Exceptional networking and negotiations skills, as well as strong public speaking/presentations skills.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

Completion of Molina /DHS/MRMIB Marketing Certification Program/Covered CA Certified.

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:

Master's Degree in Healthcare Management (preferred)

PREFERRED EXPERIENCE:

- Previous grassroots/community outreach experience a plus.

- Experience managing large teams of -enrollment and marketing - people.

- Preferred experience in project management or event coordination.

- Fluency in a second language highly desirable.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

- Active Life & Health Insurance

- Market Place Certified

PHYSICAL DEMANDS:

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

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

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long-term health care needs? Then TMG wants to hear from you!

We're currently looking for someone with a social services or human services background to join our team. This is a remote position, where you will partner with people in your community who are enrolled in the Wisconsin IRIS Program and the TMG IRIS Consultant Agency. While your office will be home-based, you will have regularly scheduled visits with IRIS participants in their home and community.

As an IRIS Consultant (IC), you will build relationships with the people you partner with and help them navigate and get the most out of the Wisconsin IRIS program - a Medicaid long-term care option for older adults and people with disabilities. You can learn more about the IRIS program on the Wisconsin Department of Health Services website here (https://dhs.wisconsin.gov/iris/index.htm) . Together, you will identify the long-term care goals of the people enrolled in IRIS, and find creative ways to achieve those goals.

ICs play an important role in helping people of various backgrounds and abilities live the lives that they choose. In fact, people constantly tell us how supportive our ICs are and what a positive impact our ICs have had on their lives! Successful candidates for this position will be compassionate, genuine, resourceful partners with an eye for high quality work, and who are excited to work side-by side with people enrolled in IRIS.

As an IC, you will connect people to the resources available in their community. You will also help them develop customized IRIS plans for achieving their goals related to employment, housing, health, safety, community membership, transportation, and lasting relationships. While you will have a routine for the work that you do, no two days are alike!

TMG wants to find the best possible candidates, so we created this Realistic Job Preview to provide you with an inside look at the position and our organization. Find out more about the IRIS Consultant position by clicking on the link (https://www.youtube.com/watch?v=2vCojx1dK3I) and then reviewing the job posting below.

TMG is committed to maintaining a diverse and inclusive workforce and prioritizes helping staff have a good work/life balance. Even though the position is remote, you'll have lots of support from your TMG team and coworkers across the organization. If this sounds like the job for you, apply today!

KNOWLEDGE/SKILLS/ABILITIES

• Required to meet in person with the IRIS participant a minimum of four times per year, with one required annual visit in the home of the participant. Because IRIS is a self-directed program, it is important for ICs to be available upon the request of the participant.

• Responsible for providing program orientation to new participants. During this time, participants will learn their rights and responsibilities as someone enrolled in the IRIS program, including verifying legal documents, completing employee paperwork and the responsible use of public dollars.

• Explore a broad view of the participant's life, including goals, important relationships, connections with the local community, interest in employment, awareness of the Self-Directed Personal Care option, and back-up support plans.

• Assist participants in identifying personal outcomes and ensure those outcomes are being met on an ongoing basis, all while staying within the participant's IRIS budget and within the requirements of the IRIS program determined by the Department of Health Services (DHS).

• Responsible for documenting all orientation and planning activities within the IRIS data system (WISITs) within 48 business hours of the visit with the participant.

• Research community resources and natural supports that will fit the individual outcomes for each participant and share that information with them as it becomes available.

• Responsible for documenting progress and changes as needed within the plan and the data system anytime a modification is requested by a participant.

• Budget Amendment or One-Time Expense paperwork may be required depending upon factors associated with the participant and their individual IRIS budget.

• Educate participants on how to read and interpret their monthly budget reports to ensure that participants operate within their budget. Being a liaison between the Fiscal Employer Agency and the IRIS Consultant Agency is also a large part of the position, which includes assisting participants with provider billing, seeking support brokers, tracking receipts, ensuring their workers are paid and mitigating areas of potential risk or conflicts of interest.

• Responsible to develop engaged and trusting relationships with participants and communicate program changes and compliance effectively.

• Responsible to maintain confidentiality and HIPPA compliance.

• Work collaboratively with other IRIS Consultant Agency staff in order to ensure a successful implementation of participants' plans.

• Attend in-person monthly team meetings with other ICs and their supervisor. In addition, weekly IC and IRIS Consultant Supervisor phone check-ins may occur, along with other duties as assigned.

JOB QUALIFICATIONS

Required Education

Bachelor's degree in a social work, psychology, human services, counseling, nursing, special education, or a closely related field (or four years of commensurate experience if no degree).

Required Experience

• 1+ year of direct experience related to the delivery of social services to the target groups (individuals with intellectual or physical disabilities and older adults).

• Ability to work independently, with minimal supervision and be self-motivated.

• Knowledge of Long-Term Care programs and familiarity with principles of self-determination.

• Excellent problem-solving skills, critical thinking skills and strong basic math skills.

• Excellent time management and prioritization skills to focus on multiple projects simultaneously and adapt to change.

• Ability to develop and maintain professional relationships and work through situations without taking it personally.

• Comfortable working within a variety of settings and adjust style as needed; to work with a diverse population, various personalities, and personal situations.

• Resourceful and have knowledge of community resources while being proactive and detail oriented.

• Ability to use a variety of technology including but not limited to, Outlook, Skype, Teams, PowerPoint, Excel, Word, online portals and databases.

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.

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: $18.04 - $35.17 / 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

Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long-term health care needs? Then TMG wants to hear from you!

We're currently looking for someone with a social services or human services background to join our team. This is a remote position, where you will partner with people in your community who are enrolled in the Wisconsin IRIS Program and the TMG IRIS Consultant Agency. While your office will be home-based, you will have regularly scheduled visits with IRIS participants in their home and community.

As an IRIS Consultant (IC), you will build relationships with the people you partner with and help them navigate and get the most out of the Wisconsin IRIS program - a Medicaid long-term care option for older adults and people with disabilities. You can learn more about the IRIS program on the Wisconsin Department of Health Services website here (https://dhs.wisconsin.gov/iris/index.htm) . Together, you will identify the long-term care goals of the people enrolled in IRIS, and find creative ways to achieve those goals.

ICs play an important role in helping people of various backgrounds and abilities live the lives that they choose. In fact, people constantly tell us how supportive our ICs are and what a positive impact our ICs have had on their lives! Successful candidates for this position will be compassionate, genuine, resourceful partners with an eye for high quality work, and who are excited to work side-by side with people enrolled in IRIS.

As an IC, you will connect people to the resources available in their community. You will also help them develop customized IRIS plans for achieving their goals related to employment, housing, health, safety, community membership, transportation, and lasting relationships. While you will have a routine for the work that you do, no two days are alike!

TMG wants to find the best possible candidates, so we created this Realistic Job Preview to provide you with an inside look at the position and our organization. Find out more about the IRIS Consultant position by clicking on the link (https://www.youtube.com/watch?v=2vCojx1dK3I) and then reviewing the job posting below.

TMG is committed to maintaining a diverse and inclusive workforce and prioritizes helping staff have a good work/life balance. Even though the position is remote, you'll have lots of support from your TMG team and coworkers across the organization. If this sounds like the job for you, apply today!

KNOWLEDGE/SKILLS/ABILITIES

• Required to meet in person with the IRIS participant a minimum of four times per year, with one required annual visit in the home of the participant. Because IRIS is a self-directed program, it is important for ICs to be available upon the request of the participant.

• Responsible for providing program orientation to new participants. During this time, participants will learn their rights and responsibilities as someone enrolled in the IRIS program, including verifying legal documents, completing employee paperwork and the responsible use of public dollars.

• Explore a broad view of the participant's life, including goals, important relationships, connections with the local community, interest in employment, awareness of the Self-Directed Personal Care option, and back-up support plans.

• Assist participants in identifying personal outcomes and ensure those outcomes are being met on an ongoing basis, all while staying within the participant's IRIS budget and within the requirements of the IRIS program determined by the Department of Health Services (DHS).

• Responsible for documenting all orientation and planning activities within the IRIS data system (WISITs) within 48 business hours of the visit with the participant.

• Research community resources and natural supports that will fit the individual outcomes for each participant and share that information with them as it becomes available.

• Responsible for documenting progress and changes as needed within the plan and the data system anytime a modification is requested by a participant.

• Budget Amendment or One-Time Expense paperwork may be required depending upon factors associated with the participant and their individual IRIS budget.

• Educate participants on how to read and interpret their monthly budget reports to ensure that participants operate within their budget. Being a liaison between the Fiscal Employer Agency and the IRIS Consultant Agency is also a large part of the position, which includes assisting participants with provider billing, seeking support brokers, tracking receipts, ensuring their workers are paid and mitigating areas of potential risk or conflicts of interest.

• Responsible to develop engaged and trusting relationships with participants and communicate program changes and compliance effectively.

• Responsible to maintain confidentiality and HIPPA compliance.

• Work collaboratively with other IRIS Consultant Agency staff in order to ensure a successful implementation of participants' plans.

• Attend in-person monthly team meetings with other ICs and their supervisor. In addition, weekly IC and IRIS Consultant Supervisor phone check-ins may occur, along with other duties as assigned.

JOB QUALIFICATIONS

Required Education

Bachelor's degree in a social work, psychology, human services, counseling, nursing, special education, or a closely related field (or four years of commensurate experience if no degree).

Required Experience

• 1+ year of direct experience related to the delivery of social services to the target groups (individuals with intellectual or physical disabilities and older adults).

• Ability to work independently, with minimal supervision and be self-motivated.

• Knowledge of Long-Term Care programs and familiarity with principles of self-determination.

• Excellent problem-solving skills, critical thinking skills and strong basic math skills.

• Excellent time management and prioritization skills to focus on multiple projects simultaneously and adapt to change.

• Ability to develop and maintain professional relationships and work through situations without taking it personally.

• Comfortable working within a variety of settings and adjust style as needed; to work with a diverse population, various personalities, and personal situations.

• Resourceful and have knowledge of community resources while being proactive and detail oriented.

• Ability to use a variety of technology including but not limited to, Outlook, Skype, Teams, PowerPoint, Excel, Word, online portals and databases.

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.

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: $18.04 - $35.17 / 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

The VP, Healthcare Services is responsible for oversight and management of the state health plan's Healthcare Services (clinical operations) teams including Utilization Management (prior-authorization, inpatient review) and Care Management (case/health management and transition of care). This position works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets.

• Works with the Healthcare Services management team to achieve successful implementation of Molina clinical strategy and direction.

• Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operations functions and promote quality cost effective health care for Molina members.

• Mentors, guides, and develops skills of management team members in a consistent and effective manner.

• Develops initiatives to achieve budgeted reductions in medical expenses and increases in quality scores.

• Develops Healthcare Services department budget and ensures budget targets are met.

• Manages implementation of analytical studies that quantify the benefits of Healthcare Services programs to ensure that resources are appropriately allocated, operational controls exist, and efficiencies are maximized.

• Facilitates integration of care coordination, long term care, behavioral health, and chemical dependency programs.

• Continually refines operational processes and champions review of team processes, workflows, and activities.

• Articulates project requirements and anticipated outcomes to the Molina Project Management Office for identified projects/strategies to improve the efficiency of clinical operations teams to meet cost and quality goals.

• Accountable for ensuring compliance with contractual, accreditation and regulatory requirements for all Healthcare Services teams.

• Participates personally or assigns appropriate staff to Molina Quality Committees and external Community Committees to represent the Healthcare Services department.

• Ensures effective inter-departmental collaboration and interaction between Healthcare Services staff and other departments.

• Ensures monthly auditing of HCS staff is performed and appropriate actions and/or coaching occur.

• Responsible for oversight of clinical training activities and outcomes.

• Responsible for HCS-related delegation oversight monitoring.

JOB QUALIFICATIONS

Required Education

Master's Degree or equivalent combination of education and work experience.

Required Experience

• 10 years managed care experience with line management responsibility including clinical operations.

• Experience working within applicable state, federal, and third-party regulations.

• Operational and process improvement experience.

• Strong communication and teaming/interpersonal skills.

• Strong leadership capabilities and ability to initiate and maintain cross-team relationships.

• Demonstrated experience meeting Quality Accreditation Standards (NCQA/HEDIS/STARS).

Required License, Certification, Association

If licensed, license must be active, unrestricted and in good standing.

Preferred Education

Master's Degree in Business or Healthcare management (i.e. MBA, MHA, MPH).

Preferred Experience

Familiarity and experience in the local market desirable.

Preferred License, Certification, Association

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

• Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification

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

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

Pay Range: $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