Company Detail

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

- 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

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

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

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

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

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 integral member of a multidisciplinary team by providing nutritional care to members as it relates to their disease and specific member care plan.

- Educates members on therapeutic dietary requirements relating to their diagnosis.

- Confers with multidisciplinary team, member, doctors, and member's family concerning dietary needs.

- Creates member specific dietary plan in accordance with individual care management care plan.

- Develops and monitors parameters to measure member/care plan success.

- Provides member with needed educational resources and on-going coaching to meet self-management goals.

- Evaluates, interprets, monitors and documents nutritional status and progress..

Job Qualifications

Required Education

Bachelor of Science; graduate of a registered dietetics program.

Required Experience

- Min. 2 years Registered Dietitian experience in outpatient/in home setting.

- Previous experience working with a multidisciplinary team.

- Experience working with culturally diverse and low-income populations.

Required License, Certification, Association

Active and unrestricted State registration as a Registered Dietitian.

Preferred Education

N/A

Preferred Experience

Managed care experience is highly desirable.

Preferred License, Certification, Association

N/A

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

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

KNOWLEDGE/SKILLS/ABILITIES

The Senior Specialist, Quality Interventions / QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.

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

• Implements key quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., removing barriers to care); preparation for Quality Improvement Compliance surveys; and other federal and state required quality activities.

• Monitors and ensures that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed.

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

• Creates, manages, and/or compiles the required documentation to maintain critical quality improvement functions.

• Leads quality improvement activities, meetings, and discussions with and between other departments within the organization.

• Evaluates project/program activities and results to identify opportunities for improvement.

• Surfaces to Manager and Director any gaps in processes that may require remediation.

• Other tasks, duties, projects, and programs as assigned.

JOB QUALIFICATIONS

Required Education

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

Required Experience

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

• Demonstrated solid business writing experience.

• Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Preferred Education

Preferred field: Clinical Quality, Public Health or Healthcare.

Preferred Experience

• 1 year of experience in Medicare and in Medicaid.

• Experience with data reporting, analysis and/or interpretation.

Preferred License, Certification, Association

• Active, unrestricted Certified Professional in Health Quality (CPHQ)

• Active, unrestricted Nursing License (RN may be preferred for specific roles)

• Active, unrestricted Certified HEDIS Compliance Auditor (CHCA)

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: $44,936.59 - $97,362.61 / ANNUAL

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background

REQUIRED EXPERIENCE:

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

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

PREFERRED EXPERIENCE:

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

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing

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: $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 Summary

As a project subject matter expert, the AVP is a strategic thought partner and leader in the successful development and implementation of new programs, with a primary focus on behavioral health, and initiatives in collaboration with the health plan, providers and various stakeholders across the Commonwealth. This position delivers strategic planning, project management, and process improvement services to customers across the organization.

Knowledge/Skills/Abilities

. Leads and oversees portfolio of programs and projects, including resourcing, to deliver against the plan; ensures scope, schedule, and objectives are defined and delivered

. Accountable for ensuring markets and shared service partners are compliant with federal and regulatory mandates and guidance

. Leads, directs, and oversees the implementation and launch of new programs and initiatives in collaboration with health plan and shared service partners, ensuring deadlines are met on schedule and within budget

. Oversees all aspects of program management; creates clear program governance and defines escalation paths for resolution of decisions, risks and issues

. Conducts long-term planning and leads complex cross-functional programs and engagements that contribute to the strategic direction of the business

. Identifies and implements process improvements and efficiencies

. Leads and develops a high-performing team, providing on-going feedback, developing technical capabilities, and fostering a culture of continual learning and business improvement

. Leads the team in achieving high levels of operational consistency by participating in monthly Operations meetings with regional plan management

. Offers insight into product performance across functional areas that include operations, quality, and risk adjustment

Job Qualifications

REQUIRED EDUCATION:

Bachelor's degree

REQUIRED EXPERIENCE:

. 10+ Years in managed care, healthcare consulting, or experience in membership-based programs

. 10+ years of experience in behavioral health systems, including the development and deployment of new programs and initiatives.

. 7+ years of program and project management experience

. 5+ years proven knowledge of Government-sponsored healthcare (Medicaid/Medicare)

. Deep knowledge of the Virginia behavioral health system and an established network with agency leaders (DBHDS, DMAS, VDH) and BH providers (both public and private)

. Experience working within, or as a contractor to, government agencies and/or regulatory bodies and interpreting state regulatory code.Experience with the design of value-based care and alternative payment methodologies.

. Demonstrated ability to drive large-scale initiatives within a complex and geographically dispersed organization

. Ability to present strategies and goals in an inspirational manner to large cross-functional teams

. Ability to adapt approach quickly and easily

. Ability to make sound decisions in ambiguous or difficult situations, synthesizing information from multiple sources and using it for effective decision-making

. Strong interpersonal, organizational, and communication skills (written & verbal)

. Demonstrated strong performance management and people development skills

PREFERRED EDUCATION:

MBA or Masters preferred

Behavioral Health Clinical License (LCSW, LPCC, LP, RN)

PREFERRED EXPERIENCE:

Experience with Agile or Lean Six Sigma methodologies a plus

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: $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

• 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.

• Member of state's plan senior leadership team

KNOWLEDGE/SKILLS/ABILITIES

- In partnership with executive leadership, develops, implements and monitors a successful strategy to achieve Molina's enrollment growth goals for a large/complex state plan for Medicaid.

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

- Develops growth strategy by market/product and determines representative coverage, focusing on profitable growth.

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

- In accordance with corporate guidelines, establishes 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, plans, delegates and manages 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

REQU I RED ED U C A TI O N :

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

REQU I RED E X PE R I E N C E:

- 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.

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

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.

PR E FE R RED ED U C A TI O N :

Master's Degree in Healthcare Management (preferred)

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

- 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.

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

- Active Life & Health Insurance

- Market Place Certified

PHY S I C AL DEM A N D S :

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

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

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

Pay Range: $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

*Remote and must live in Nebraska*

Job Description

Job Summary

Molina Health Plan Network Provider Relations 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 Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

Job Duties

This role serves as the primary point of contact between Molina Health plan and the Plan's highest priority, high volume and strategic non-complex Provider Community that services Molina members, including but not limited to Fee-For-Service and Pay for Performance Providers. It is an external-facing, field-based position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage high priority providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.

- Under general supervision, works directly with the Plan's external providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. Effectiveness in driving timely issue resolution, EMR connectivity, Provider Portal Adoption.

- Resolves complex provider issues that may cross departmental lines and involve Senior Leadership.

- Serves as a subject matter expert for other departments.

- Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.

- Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship.

- Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters.

- Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. For example, such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding.

- Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's).

- Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include: administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.).

- Trains other Provider Relations Representatives as appropriate.

- Role requires 80%+ same-day or overnight travel. (Extent of overnight travel will depend on the specific Health Plan and its service area.)

Job Qualifications

REQUIRED EDUCATION :

Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

- 3 - 5 years customer service, provider service, or claims experience in a managed care setting.

- 3+ years experience in managed healthcare administration and/or Provider Services.

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

PREFERRED EXPERIENCE :

- 5+ years experience in managed healthcare administration and/or Provider Services.

- 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, groups and hospitals).

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

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

Pay Range: $49,930 - $97,363 a year*

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

Job Detail

• Company:
  Molina Healthcare

Job Description

*Remote and must live in Nebraska or a boarding state*

JOB DESCRIPTION

Job Summary

Negotiates agreements with highly visible providers who are strategic to the success of the Plan, including integrated delivery systems, hospitals and physician groups that result in high quality, cost effective and marketable providers.

KNOWLEDGE/SKILLS/ABILITIES

• In conjunction with Director/Manager Provider Contracts, negotiates high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.

• Develops and maintains provider contracts in APTTUS contract management software.

• Targets and recruits additional providers to reduce member access grievances.

• Engages targeted contracted providers in renegotiation of rates and/or language. Assists with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region.

• Maintains contractual relationships with significant/highly visible providers.

• Advises Network Provider Contract Coordinators and Specialists on negotiation of individual provider and routine ancillary contracts.

• Evaluates provider network and implement strategic plans with the goal of meeting Molina's network adequacy standards.

• Assesses contract language for compliance with Corporate standards and regulatory requirements and review revised language with assigned MHI attorney.

• Participates in fee schedule determinations including development of new reimbursement models. Seeks input on new reimbursement models from Corporate Network Management and legal.

• Educates internal customers on provider contracts.

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

JOB QUALIFICATIONS

Required Education

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

Required Experience

5-7 years

Preferred Education

Graduate 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: $66,456.22 - $129,589.63 a year*

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

Job Detail

• Company:
  Molina Healthcare

Job Description

*Remote and must live in Nebraska*

Job Description

Job Summary

Molina Health Plan Network Provider Relations 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 Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

Job Duties

This role serves as the primary point of contact between Molina Health plan and the Plan's highest priority, high volume and strategic non-complex Provider Community that services Molina members, including but not limited to Fee-For-Service and Pay for Performance Providers. It is an external-facing, field-based position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage high priority providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.

- Under general supervision, works directly with the Plan's external providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. Effectiveness in driving timely issue resolution, EMR connectivity, Provider Portal Adoption.

- Resolves complex provider issues that may cross departmental lines and involve Senior Leadership.

- Serves as a subject matter expert for other departments.

- Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.

- Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship.

- Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters.

- Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. For example, such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding.

- Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's).

- Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include: administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.).

- Trains other Provider Relations Representatives as appropriate.

- Role requires 80%+ same-day or overnight travel. (Extent of overnight travel will depend on the specific Health Plan and its service area.)

Job Qualifications

REQUIRED EDUCATION :

Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

- 3 - 5 years customer service, provider service, or claims experience in a managed care setting.

- 3+ years experience in managed healthcare administration and/or Provider Services.

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

PREFERRED EXPERIENCE :

- 5+ years experience in managed healthcare administration and/or Provider Services.

- 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, groups and hospitals).

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

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

Pay Range: $49,930 - $97,363 a year*

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

Job Detail

• Company:
  Molina Healthcare