Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
JOB DESCRIPTION Job Summary Do you want a career where you build lasting...
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 diffe...
Posted - Nov 04, 2023
JOB DESCRIPTION Job Summary Do you want a career where you build lasting...
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 diffe...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
*Remote and must live in Michigan* Job Description Job Summary Responsib...
*Remote and must live in Michigan* Job Description Job Summary Responsible for accurate and timely maintenance of critical provider information on...
Posted - Nov 04, 2023
*Remote and must live in Michigan* Job Description Job Summary Responsib...
*Remote and must live in Michigan* Job Description Job Summary Responsible for accurate and timely maintenance of critical provider information on...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 04, 2023
Molina's Customer Experience team has several opportunities within our orga...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of bus...
Posted - Nov 03, 2023
JOB DESCRIPTION Remote opportunity, candidate MUST reside in the State of...
JOB DESCRIPTION Remote opportunity, candidate MUST reside in the State of Ohio. Job Summary Responsible for leading, organizing and directing the a...
Posted - Nov 03, 2023
JOB DESCRIPTION Remote opportunity, candidate MUST reside in the State of...
JOB DESCRIPTION Remote opportunity, candidate MUST reside in the State of Ohio. Job Summary Responsible for leading, organizing and directing the a...
Posted - Nov 03, 2023
Job Description Job Summary The Health Plan Chief Medical Officer provide...
Job Description Job Summary The Health Plan Chief Medical Officer provides leadership in the development and execution of the Plan's disease managem...
Posted - Nov 03, 2023
Job Description Job Summary The Health Plan Chief Medical Officer provide...
Job Description Job Summary The Health Plan Chief Medical Officer provides leadership in the development and execution of the Plan's disease managem...
Posted - Nov 03, 2023
Job Description Job Summary The Health Plan Chief Medical Officer provide...
Job Description Job Summary The Health Plan Chief Medical Officer provides leadership in the development and execution of the Plan's disease managem...
Posted - Nov 03, 2023
Job Description Job Summary The Health Plan Chief Medical Officer provide...
Job Description Job Summary The Health Plan Chief Medical Officer provides leadership in the development and execution of the Plan's disease managem...
Posted - Nov 03, 2023
JOB DESCRIPTION Job Summary The Marketplace Facilitated Enroller (MFE) is...
JOB DESCRIPTION Job Summary The Marketplace Facilitated Enroller (MFE) is responsible for identifying prospective members that do not have health in...
Posted - Nov 03, 2023
JOB DESCRIPTION Job Summary The Marketplace Facilitated Enroller (MFE) is...
JOB DESCRIPTION Job Summary The Marketplace Facilitated Enroller (MFE) is responsible for identifying prospective members that do not have health in...
Posted - Nov 02, 2023
JOB DESCRIPTION Job Summary Molina Healthcare Services (HCS) works with m...
JOB DESCRIPTION Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate,...
Posted - Nov 02, 2023
JOB DESCRIPTION Job Summary Molina Healthcare Services (HCS) works with m...
JOB DESCRIPTION Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate,...
Posted - Oct 29, 2023
JOB DESCRIPTION Job Summary Provides customer support and stellar servic...
JOB DESCRIPTION Job Summary Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues an...
Posted - Oct 29, 2023
JOB DESCRIPTION Job Summary Provides customer support and stellar servic...
JOB DESCRIPTION Job Summary Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues an...
Posted - Oct 29, 2023
JOB DESCRIPTION Job Summary Provides customer support and stellar service...
JOB DESCRIPTION Job Summary Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues an...
Posted - Oct 29, 2023
JOB DESCRIPTION Job Summary Provides customer support and stellar service...
JOB DESCRIPTION Job Summary Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues an...
Posted - Oct 29, 2023
JOB DESCRIPTION Job Summary Provides customer support and stellar servic...
JOB DESCRIPTION Job Summary Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues an...
Posted - Oct 29, 2023
JOB DESCRIPTION Job Summary Provides customer support and stellar servic...
JOB DESCRIPTION Job Summary Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues an...
Posted - Oct 28, 2023
JOB DESCRIPTION Case Manager opportunity in the Champaign, IL service area...
JOB DESCRIPTION Case Manager opportunity in the Champaign, IL service area available for either an IL licensed LPN or a Bachelors trained social serv...
Posted - Oct 28, 2023
JOB DESCRIPTION Case Manager opportunity in the Champaign, IL service area...
JOB DESCRIPTION Case Manager opportunity in the Champaign, IL service area available for either an IL licensed LPN or a Bachelors trained social serv...
Posted - Oct 27, 2023
Molina Healthcare is hiring for several Peer Support Specialists (Mental...
Molina Healthcare is hiring for several Peer Support Specialists (Mental Health and/or Substance Use Disorders) in Nebraska. Peer Support Speciali...
Posted - Oct 27, 2023
Molina Healthcare is hiring for several Peer Support Specialists (Mental...
Molina Healthcare is hiring for several Peer Support Specialists (Mental Health and/or Substance Use Disorders) in Nebraska. Peer Support Speciali...
Posted - Oct 27, 2023
Molina Healthcare is hiring for several Peer Support Specialists (Mental...
Molina Healthcare is hiring for several Peer Support Specialists (Mental Health and/or Substance Use Disorders) in Nebraska. Peer Support Speciali...
Posted - Oct 27, 2023
Molina Healthcare is hiring for several Peer Support Specialists (Mental...
Molina Healthcare is hiring for several Peer Support Specialists (Mental Health and/or Substance Use Disorders) in Nebraska. Peer Support Speciali...
Posted - Oct 27, 2023
JOB DESCRIPTION Opportunity for IL licensed LPN or Bachelors/Masters train...
JOB DESCRIPTION Opportunity for IL licensed LPN or Bachelors/Masters trained, experienced Case Manager to work for our Health Plan in Illinois. Meeti...
Posted - Oct 27, 2023
JOB DESCRIPTION Opportunity for IL licensed LPN or Bachelors/Masters train...
JOB DESCRIPTION Opportunity for IL licensed LPN or Bachelors/Masters trained, experienced Case Manager to work for our Health Plan in Illinois. Meeti...
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of businesses across multiple states. We are committed to providing excellent customer service to our members and providers. We have competitive benefits along with a clear career path to allow growth within 6-8 months. This role is a remote position and salary will be based on experience you bring to Molina!
Molina is a fast-pace, energetic organization and is committed to caring for our customers. This role provides customer support and requires stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences
JOB DESCRIPTION
Job Summary
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.
KNOWLEDGE/SKILLS/ABILITIES
Support Inbound/Outbound phone calls from Members or Providers on routine or simple issues.
Conduct varies surveys related to health assessments and member satisfaction.
Accurately document pertinent details related to Member or Provider calls.
Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.
Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations.
Aptitude to listen attentively, capture relevant information, and identify Member or Provider's inquiries and concerns.
Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.
Able to proactively engage and collaborate with varies Internal/ External departments.
Personal responsibility and accountability by taking ownership of providing resolutions in real time or through timely follow up with the Member and/or Provider.
Supports provider needs for basic inquiries and assistance involving member eligibility and covered benefits, Provider Portal, and status of submitted claims.
Ability to effectively communicate in a professionally setting.
Preferred Systems Training:
Microsoft Office
Genesys
Salesforce
Pega
QNXT
CRM
Verint
Kronos
Microsoft Teams
Video Conferencing
CVS Caremark
Availity
JOB QUALIFICATIONS
REQUIRED EDUCATION:
HS Diploma or equivalent combination of education and experience
REQUIRED EXPERIENCE:
1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment
PREFERRED EDUCATION:
Associate's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
1-3 years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCC
#LI-BEMORE
Pay Range: $11.09 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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/hr - $35.17/hr*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
#PJHS
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of businesses across multiple states. We are committed to providing excellent customer service to our members and providers. We have competitive benefits along with a clear career path to allow growth within 6-8 months. This role is a remote position and salary will be based on experience you bring to Molina!
Molina is a fast-pace, energetic organization and is committed to caring for our customers. This role provides customer support and requires stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences
JOB DESCRIPTION
Job Summary
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.
KNOWLEDGE/SKILLS/ABILITIES
Support Inbound/Outbound phone calls from Members or Providers on routine or simple issues.
Conduct varies surveys related to health assessments and member satisfaction.
Accurately document pertinent details related to Member or Provider calls.
Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.
Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations.
Aptitude to listen attentively, capture relevant information, and identify Member or Provider's inquiries and concerns.
Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.
Able to proactively engage and collaborate with varies Internal/ External departments.
Personal responsibility and accountability by taking ownership of providing resolutions in real time or through timely follow up with the Member and/or Provider.
Supports provider needs for basic inquiries and assistance involving member eligibility and covered benefits, Provider Portal, and status of submitted claims.
Ability to effectively communicate in a professionally setting.
Preferred Systems Training:
Microsoft Office
Genesys
Salesforce
Pega
QNXT
CRM
Verint
Kronos
Microsoft Teams
Video Conferencing
CVS Caremark
Availity
JOB QUALIFICATIONS
REQUIRED EDUCATION:
HS Diploma or equivalent combination of education and experience
REQUIRED EXPERIENCE:
1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment
PREFERRED EDUCATION:
Associate's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
1-3 years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCC
#LI-BEMORE
Pay Range: $11.09 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of businesses across multiple states. We are committed to providing excellent customer service to our members and providers. We have competitive benefits along with a clear career path to allow growth within 6-8 months. This role is a remote position and salary will be based on experience you bring to Molina!
Molina is a fast-pace, energetic organization and is committed to caring for our customers. This role provides customer support and requires stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences
JOB DESCRIPTION
Job Summary
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.
KNOWLEDGE/SKILLS/ABILITIES
Support Inbound/Outbound phone calls from Members or Providers on routine or simple issues.
Conduct varies surveys related to health assessments and member satisfaction.
Accurately document pertinent details related to Member or Provider calls.
Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.
Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations.
Aptitude to listen attentively, capture relevant information, and identify Member or Provider's inquiries and concerns.
Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.
Able to proactively engage and collaborate with varies Internal/ External departments.
Personal responsibility and accountability by taking ownership of providing resolutions in real time or through timely follow up with the Member and/or Provider.
Supports provider needs for basic inquiries and assistance involving member eligibility and covered benefits, Provider Portal, and status of submitted claims.
Ability to effectively communicate in a professionally setting.
Preferred Systems Training:
Microsoft Office
Genesys
Salesforce
Pega
QNXT
CRM
Verint
Kronos
Microsoft Teams
Video Conferencing
CVS Caremark
Availity
JOB QUALIFICATIONS
REQUIRED EDUCATION:
HS Diploma or equivalent combination of education and experience
REQUIRED EXPERIENCE:
1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment
PREFERRED EDUCATION:
Associate's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
1-3 years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCC
#LI-BEMORE
Pay Range: $11.09 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of businesses across multiple states. We are committed to providing excellent customer service to our members and providers. We have competitive benefits along with a clear career path to allow growth within 6-8 months. This role is a remote position and salary will be based on experience you bring to Molina!
Molina is a fast-pace, energetic organization and is committed to caring for our customers. This role provides customer support and requires stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences
JOB DESCRIPTION
Job Summary
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.
KNOWLEDGE/SKILLS/ABILITIES
Support Inbound/Outbound phone calls from Members or Providers on routine or simple issues.
Conduct varies surveys related to health assessments and member satisfaction.
Accurately document pertinent details related to Member or Provider calls.
Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.
Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations.
Aptitude to listen attentively, capture relevant information, and identify Member or Provider's inquiries and concerns.
Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.
Able to proactively engage and collaborate with varies Internal/ External departments.
Personal responsibility and accountability by taking ownership of providing resolutions in real time or through timely follow up with the Member and/or Provider.
Supports provider needs for basic inquiries and assistance involving member eligibility and covered benefits, Provider Portal, and status of submitted claims.
Ability to effectively communicate in a professionally setting.
Preferred Systems Training:
Microsoft Office
Genesys
Salesforce
Pega
QNXT
CRM
Verint
Kronos
Microsoft Teams
Video Conferencing
CVS Caremark
Availity
JOB QUALIFICATIONS
REQUIRED EDUCATION:
HS Diploma or equivalent combination of education and experience
REQUIRED EXPERIENCE:
1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment
PREFERRED EDUCATION:
Associate's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
1-3 years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCC
#LI-BEMORE
Pay Range: $11.09 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of businesses across multiple states. We are committed to providing excellent customer service to our members and providers. We have competitive benefits along with a clear career path to allow growth within 6-8 months. This role is a remote position and salary will be based on experience you bring to Molina!
Molina is a fast-pace, energetic organization and is committed to caring for our customers. This role provides customer support and requires stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences
JOB DESCRIPTION
Job Summary
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.
KNOWLEDGE/SKILLS/ABILITIES
Support Inbound/Outbound phone calls from Members or Providers on routine or simple issues.
Conduct varies surveys related to health assessments and member satisfaction.
Accurately document pertinent details related to Member or Provider calls.
Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.
Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations.
Aptitude to listen attentively, capture relevant information, and identify Member or Provider's inquiries and concerns.
Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.
Able to proactively engage and collaborate with varies Internal/ External departments.
Personal responsibility and accountability by taking ownership of providing resolutions in real time or through timely follow up with the Member and/or Provider.
Supports provider needs for basic inquiries and assistance involving member eligibility and covered benefits, Provider Portal, and status of submitted claims.
Ability to effectively communicate in a professionally setting.
Preferred Systems Training:
Microsoft Office
Genesys
Salesforce
Pega
QNXT
CRM
Verint
Kronos
Microsoft Teams
Video Conferencing
CVS Caremark
Availity
JOB QUALIFICATIONS
REQUIRED EDUCATION:
HS Diploma or equivalent combination of education and experience
REQUIRED EXPERIENCE:
1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment
PREFERRED EDUCATION:
Associate's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
1-3 years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCC
#LI-BEMORE
Pay Range: $11.09 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of businesses across multiple states. We are committed to providing excellent customer service to our members and providers. We have competitive benefits along with a clear career path to allow growth within 6-8 months. This role is a remote position and salary will be based on experience you bring to Molina!
Molina is a fast-pace, energetic organization and is committed to caring for our customers. This role provides customer support and requires stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences
JOB DESCRIPTION
Job Summary
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.
KNOWLEDGE/SKILLS/ABILITIES
Support Inbound/Outbound phone calls from Members or Providers on routine or simple issues.
Conduct varies surveys related to health assessments and member satisfaction.
Accurately document pertinent details related to Member or Provider calls.
Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.
Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations.
Aptitude to listen attentively, capture relevant information, and identify Member or Provider's inquiries and concerns.
Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.
Able to proactively engage and collaborate with varies Internal/ External departments.
Personal responsibility and accountability by taking ownership of providing resolutions in real time or through timely follow up with the Member and/or Provider.
Supports provider needs for basic inquiries and assistance involving member eligibility and covered benefits, Provider Portal, and status of submitted claims.
Ability to effectively communicate in a professionally setting.
Preferred Systems Training:
Microsoft Office
Genesys
Salesforce
Pega
QNXT
CRM
Verint
Kronos
Microsoft Teams
Video Conferencing
CVS Caremark
Availity
JOB QUALIFICATIONS
REQUIRED EDUCATION:
HS Diploma or equivalent combination of education and experience
REQUIRED EXPERIENCE:
1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment
PREFERRED EDUCATION:
Associate's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
1-3 years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCC
#LI-BEMORE
Pay Range: $11.09 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of businesses across multiple states. We are committed to providing excellent customer service to our members and providers. We have competitive benefits along with a clear career path to allow growth within 6-8 months. This role is a remote position and salary will be based on experience you bring to Molina!
Molina is a fast-pace, energetic organization and is committed to caring for our customers. This role provides customer support and requires stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences
JOB DESCRIPTION
Job Summary
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.
KNOWLEDGE/SKILLS/ABILITIES
Support Inbound/Outbound phone calls from Members or Providers on routine or simple issues.
Conduct varies surveys related to health assessments and member satisfaction.
Accurately document pertinent details related to Member or Provider calls.
Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.
Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations.
Aptitude to listen attentively, capture relevant information, and identify Member or Provider's inquiries and concerns.
Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.
Able to proactively engage and collaborate with varies Internal/ External departments.
Personal responsibility and accountability by taking ownership of providing resolutions in real time or through timely follow up with the Member and/or Provider.
Supports provider needs for basic inquiries and assistance involving member eligibility and covered benefits, Provider Portal, and status of submitted claims.
Ability to effectively communicate in a professionally setting.
Preferred Systems Training:
Microsoft Office
Genesys
Salesforce
Pega
QNXT
CRM
Verint
Kronos
Microsoft Teams
Video Conferencing
CVS Caremark
Availity
JOB QUALIFICATIONS
REQUIRED EDUCATION:
HS Diploma or equivalent combination of education and experience
REQUIRED EXPERIENCE:
1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment
PREFERRED EDUCATION:
Associate's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
1-3 years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCC
#LI-BEMORE
Pay Range: $11.09 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of businesses across multiple states. We are committed to providing excellent customer service to our members and providers. We have competitive benefits along with a clear career path to allow growth within 6-8 months. This role is a remote position and salary will be based on experience you bring to Molina!
Molina is a fast-pace, energetic organization and is committed to caring for our customers. This role provides customer support and requires stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences
JOB DESCRIPTION
Job Summary
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.
KNOWLEDGE/SKILLS/ABILITIES
Support Inbound/Outbound phone calls from Members or Providers on routine or simple issues.
Conduct varies surveys related to health assessments and member satisfaction.
Accurately document pertinent details related to Member or Provider calls.
Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.
Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations.
Aptitude to listen attentively, capture relevant information, and identify Member or Provider's inquiries and concerns.
Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.
Able to proactively engage and collaborate with varies Internal/ External departments.
Personal responsibility and accountability by taking ownership of providing resolutions in real time or through timely follow up with the Member and/or Provider.
Supports provider needs for basic inquiries and assistance involving member eligibility and covered benefits, Provider Portal, and status of submitted claims.
Ability to effectively communicate in a professionally setting.
Preferred Systems Training:
Microsoft Office
Genesys
Salesforce
Pega
QNXT
CRM
Verint
Kronos
Microsoft Teams
Video Conferencing
CVS Caremark
Availity
JOB QUALIFICATIONS
REQUIRED EDUCATION:
HS Diploma or equivalent combination of education and experience
REQUIRED EXPERIENCE:
1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment
PREFERRED EDUCATION:
Associate's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
1-3 years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCC
#LI-BEMORE
Pay Range: $11.09 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of businesses across multiple states. We are committed to providing excellent customer service to our members and providers. We have competitive benefits along with a clear career path to allow growth within 6-8 months. This role is a remote position and salary will be based on experience you bring to Molina!
Molina is a fast-pace, energetic organization and is committed to caring for our customers. This role provides customer support and requires stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences
JOB DESCRIPTION
Job Summary
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.
KNOWLEDGE/SKILLS/ABILITIES
Support Inbound/Outbound phone calls from Members or Providers on routine or simple issues.
Conduct varies surveys related to health assessments and member satisfaction.
Accurately document pertinent details related to Member or Provider calls.
Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.
Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations.
Aptitude to listen attentively, capture relevant information, and identify Member or Provider's inquiries and concerns.
Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.
Able to proactively engage and collaborate with varies Internal/ External departments.
Personal responsibility and accountability by taking ownership of providing resolutions in real time or through timely follow up with the Member and/or Provider.
Supports provider needs for basic inquiries and assistance involving member eligibility and covered benefits, Provider Portal, and status of submitted claims.
Ability to effectively communicate in a professionally setting.
Preferred Systems Training:
Microsoft Office
Genesys
Salesforce
Pega
QNXT
CRM
Verint
Kronos
Microsoft Teams
Video Conferencing
CVS Caremark
Availity
JOB QUALIFICATIONS
REQUIRED EDUCATION:
HS Diploma or equivalent combination of education and experience
REQUIRED EXPERIENCE:
1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment
PREFERRED EDUCATION:
Associate's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
1-3 years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCC
#LI-BEMORE
Pay Range: $11.09 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
*Remote and must live in Michigan*
Job Description
Job Summary
Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.
Knowledge/Skills/Abilities
- In conjunction with the Director, Provider Contracts, develops health plan-specific provider contracting strategies, identifying specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of the Plan's patients or members.
- Prepares the provider contracts in concert with established company guidelines with physicians, hospitals, MLTSS and other health care providers.
- Assists in achieving annual savings through recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region.
- Utilizes standardized contract templates and Pay for Performance strategies.
- Utilizes established Reimbursement Tolerance Parameters (across multiple specialties/ geographies). Oversees the development of new reimbursement models in concert with Director.
- Oversees the maintenance of all Provider and payer Contract Templates. Works with legal and Corporate Network Management on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
- Ensures compliance with applicable provider panel and network capacity, adequacy requirements and guidelines. Produces and monitors weekly/monthly reports to track and monitor compliance with network adequacy requirements.
- Develops and implements strategies to minimize the company's financial exposure. Monitors and adjusts strategy implementation as needed to achieve desire goals and reduce minimize the company's financial exposure..
Job Qualifications
Required Education
Bachelor's Degree in a related field (Business Administration, etc.,) or equivalent 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: $73,101 - $142,549 a year*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level
Pay Range: $65,791.66 - $142,548.59 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Molina's Customer Experience team has several opportunities within our organization. Molina supports members and providers for different lines of businesses across multiple states. We are committed to providing excellent customer service to our members and providers. We have competitive benefits along with a clear career path to allow growth within 6-8 months. This role is a remote position and salary will be based on experience you bring to Molina!
Molina is a fast-pace, energetic organization and is committed to caring for our customers. This role provides customer support and requires stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences
JOB DESCRIPTION
Job Summary
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.
KNOWLEDGE/SKILLS/ABILITIES
Support Inbound/Outbound phone calls from Members or Providers on routine or simple issues.
Conduct varies surveys related to health assessments and member satisfaction.
Accurately document pertinent details related to Member or Provider calls.
Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.
Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations.
Aptitude to listen attentively, capture relevant information, and identify Member or Provider's inquiries and concerns.
Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.
Able to proactively engage and collaborate with varies Internal/ External departments.
Personal responsibility and accountability by taking ownership of providing resolutions in real time or through timely follow up with the Member and/or Provider.
Supports provider needs for basic inquiries and assistance involving member eligibility and covered benefits, Provider Portal, and status of submitted claims.
Ability to effectively communicate in a professionally setting.
Preferred Systems Training:
Microsoft Office
Genesys
Salesforce
Pega
QNXT
CRM
Verint
Kronos
Microsoft Teams
Video Conferencing
CVS Caremark
Availity
JOB QUALIFICATIONS
REQUIRED EDUCATION:
HS Diploma or equivalent combination of education and experience
REQUIRED EXPERIENCE:
1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment
PREFERRED EDUCATION:
Associate's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
1-3 years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCC
#LI-BEMORE
Pay Range: $11.09 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
JOB DESCRIPTION
Remote opportunity, candidate MUST reside in the State of Ohio.
Job Summary
Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider complaints and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid
KNOWLEDGE/SKILLS/ABILITIES
Manages staff responsible for the submission/resolution of member and provider inquiries, appeals and grievances for the Plan. Ensures resolutions are compliant.
Proactively assesses and audits business processes to determine those most effective and efficient at resolving member and provider problems.
Serves as primary interface with stakeholders and business partners and ensures standard processes are implemented.
Oversees preparation of narratives, graphs, flowcharts, etc. to be used for committee presentations, audits and internal/external reports; oversees necessary correspondence in accordance with regulatory requirements.
Maintains call tracking system of correspondence and outcomes for provider and member appeals/grievances; oversees monitoring of each member submission/resolution to ensure all internal and regulatory timelines are met.
JOB QUALIFICATIONS
REQUIRED EDUCATION:
Bachelor's degree or equivalent experience
REQUIRED EXPERIENCE:
Min. 6 years' experience in healthcare claims review and/or member dispute resolution.
2 years leadership experience
Experience reviewing all types of medical claims (e.g. HCFA 1500, Outpatient/Inpatient UB92, Universal Claims, Stop Loss, Surgery, Anesthesia, high dollar complicated claims, COB and DRG/RCC pricing).
Pay Range: $60,415 - $117,809a year*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
#PJClaims
#LI-BEMORE
Job Description
Job Summary
The Health Plan Chief Medical Officer provides leadership in the development and execution of the Plan's disease management, case management, utilization management, and care management programs. Oversees the development of the Plan's clinical practice guidelines and provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to Plan members, targeting improvements in efficiency and satisfaction for members and providers.
KNOWLEDGE/SKILLS/ABILITIES
Provides leadership to the health plan in the areas of strategic planning, strategy execution and implementation of care management programs, including such programs as Quality Improvement, Utilization Management, Care Management, Predictive Modeling, and Disease Management.
Leads the health plan's analysis of medical care cost and utilization data. Leads and manages the development of techniques to effectively correct identified and anticipated utilization problems while assuring that our members receive the care they need.
Provides leadership, direction and oversight functions to the health plan's medical management staff designed to achieve best in class performance as defined by identified metrics.
Offers a positive leadership role in key health plan medical management initiatives aimed at optimizing utilization of medical resources.
Oversees and directs the rendering of medical management decisions at all levels of the health plan that maximize benefits for our members while pursuing and supporting corporate objectives.
JOB QUALIFICATIONS
Required Education
Doctorate Degree in Medicine
Board Certified or eligible in a primary care specialty
Required Experience
10+ years relevant experience, including:
Minimum 5 years clinical practice.
5 years in a Medical Director role.
4 years HMO/Managed Care experience, including Utilization and/or Quality Program management.
5 years managed care administrative experience to include NCQA or URAC
Required License, Certification, Association
Active and unrestricted Current State Medical License without restrictions (free of sanctions from Medicaid or Medicare)
Active and unrestricted current Drug Enforcement Agency Certificate
Preferred Education
Master's in business administration, Public Health, Healthcare Administration, etc.
Preferred Experience
12+ years relevant experience
Peer Review, medical policy/procedure development, provider contracting experience.
Preferred License, Certification, Association
Active and unrestricted Board Certification (Pediatrics, Family Practice, Ob/Gyn or Internal Medicine).
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: $246,251.34 - $480,190.11 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Job Description
Job Summary
The Health Plan Chief Medical Officer provides leadership in the development and execution of the Plan's disease management, case management, utilization management, and care management programs. Oversees the development of the Plan's clinical practice guidelines and provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to Plan members, targeting improvements in efficiency and satisfaction for members and providers.
KNOWLEDGE/SKILLS/ABILITIES
Provides leadership to the health plan in the areas of strategic planning, strategy execution and implementation of care management programs, including such programs as Quality Improvement, Utilization Management, Care Management, Predictive Modeling, and Disease Management.
Leads the health plan's analysis of medical care cost and utilization data. Leads and manages the development of techniques to effectively correct identified and anticipated utilization problems while assuring that our members receive the care they need.
Provides leadership, direction and oversight functions to the health plan's medical management staff designed to achieve best in class performance as defined by identified metrics.
Offers a positive leadership role in key health plan medical management initiatives aimed at optimizing utilization of medical resources.
Oversees and directs the rendering of medical management decisions at all levels of the health plan that maximize benefits for our members while pursuing and supporting corporate objectives.
JOB QUALIFICATIONS
Required Education
Doctorate Degree in Medicine
Board Certified or eligible in a primary care specialty
Required Experience
10+ years relevant experience, including:
Minimum 5 years clinical practice.
5 years in a Medical Director role.
4 years HMO/Managed Care experience, including Utilization and/or Quality Program management.
5 years managed care administrative experience to include NCQA or URAC
Required License, Certification, Association
Active and unrestricted Current State Medical License without restrictions (free of sanctions from Medicaid or Medicare)
Active and unrestricted current Drug Enforcement Agency Certificate
Preferred Education
Master's in business administration, Public Health, Healthcare Administration, etc.
Preferred Experience
12+ years relevant experience
Peer Review, medical policy/procedure development, provider contracting experience.
Preferred License, Certification, Association
Active and unrestricted Board Certification (Pediatrics, Family Practice, Ob/Gyn or Internal Medicine).
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: $246,251.34 - $480,190.11 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
JOB DESCRIPTION
Job Summary
The Marketplace Facilitated Enroller (MFE) is responsible for identifying prospective members that do not have health insurance and assisting with the enrollment process ultimately making it easier for them to connect to the care they need. The MFE conducts interviews and screens potentially eligible recipients for enrollment into Government Programs such as Medicaid/Medicaid Managed Care, Child Health Plus and Essential Plan. Additionally, the MFE will assist in enrollment into Qualified Health Plans. The MFE must offer all plans and all products. MFEs assist families with their applications, provides assistance with completing the application, gathers the necessary documentation, and assists in selection of the appropriate health plan. The Enroller provides information on managed care programs and how to access care. The MFE is responsible for processing paperwork completely and accurately, including follow up visit documentation and other necessary reports. The MFE is also responsible for assisting current members with recertification with their plan. MFEs must source, develop and maintain professional, congenial relationships with local community agencies as well as county and state agency personnel who refer potentially eligible recipients.
KNOWLEDGE/SKILLS/ABILITIES
Responsible for achieving monthly, quarterly, and annual enrollment goals and growth targets, as established by management.
Interview, screen and assist potentially eligible recipients with the enrollment process into Medicaid/Medicaid Managed Care, Child Health Plus the Essential Plan and Qualified Health Plans for Molina and other plans who operate in our service area
Meet with consumers at various sites throughout the communities
Provide education and support to individuals who are navigating a complex system by assisting consumers with the application process, explaining requirements and necessary documentation
Identify and educate potential members on all aspects of the plan including answering questions regarding plan's features and benefits and walking client through the required disclosures
Educate members on their options to make premium payments, including due dates
Assist clients with choosing a plan and primary care physician
Submit all completed applications, adhering to submission deadline dates as imposed by NYSOH and Molina enrollment guidelines and requirements
Responsible for identifying and assisting current members who are due to re-certify their healthcare coverage by completing the annual recertification application including adding on additional eligible family members
Respond to inquiries from prospective members and members within the marketing guidelines
Must adhere to all NYSOH rules and regulations as applicable for MFE functions
Outreach Projects
Participate in events and community outreach projects to other agencies as assigned by Management for a minimum of 8 hours per week
Establish and maintain good working relationships with external business partners such as hospital and provider
organizations, city agencies and community-based organizations where enrollment activities are conducted
Develop and strengthen relations to generate new opportunities
Attend external meetings as required
Attend community health fairs and events as required
Occasional weekend or evening availability for special events.
JOB QUALIFICATIONS
Required Education
HS Diploma
Required Experience
Minimum one year of experience working with State and Federal Health Insurance programs and populations
Demonstrated organizational skills, time management skills and ability to work independently
Ability to meet deadlines
Excellent written and oral communication skills; strong presentation skills
Basic computer skills including Microsoft Word and Excel
Strong interpersonal skills
A positive attitude with ability to adapt to change
Must have reliable transportation and a valid NYS drivers' license with no restrictions
Knowledge of Managed Care insurance plans
Ability to work with a diverse population, including different ethnicities, cultural backgrounds, and/or underserved communities
Ability to work a flexible schedule, including nights and weekends
Required License, Certification, Association
Successful completion of the NYSOH required training, certification and recertification
Preferred Education
AA/AS - Associates degree
Preferred Experience
Previous experience as a Marketplace Facilitated Enroller - Bilingual - Spanish & English
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.
JOB DESCRIPTION
Job Summary
Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
This position will support our Senior Whole Health business. Senior Whole Health by Molina is a Managed Long-Term Care (MLTC), and Medicaid Advantage (MAP) plan. These plans streamline the delivery of long-term services to chronically ill or disabled people who are eligible for Medicaid and Medicare. We are looking for Registered Nurse Care Review Clinicians, Inpatient Review with Utilization Management (UM) experience.
Remote position. Work hours: Monday - Friday 8:30am - 5:00pm EST.
KNOWLEDGE/SKILLS/ABILITIES
Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.
Processes requests within required timelines.
Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.
Requests additional information from members or providers in consistent and efficient manner.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote Molina Care Model.
Adheres to UM policies and procedures.
Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.
JOB QUALIFICATIONS
Required Education
Graduate from an Accredited School of Nursing.
Required Experience
3+ years hospital acute care/medical experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
NY unrestricted licensure
State Specific Requirements:
IL Qualifications: Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment
Preferred Education
Bachelor's Degree in Nursing
Preferred Experience
Recent hospital experience in ICU, Medical, or ER unit.
UM experience
MS Office- proficient experience with Word and Excel highly preferred.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
Pay Range: $26.41 - $51.49 an hour*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
JOB DESCRIPTION
Job Summary
Provides customer support and stellar service to meet the needs of our Molina members and providers.
Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions.
Provides product and service information and identifies opportunities to improve our member and provider experiences.
KNOWLEDGE/SKILLS/ABILITIES
Supervises a team of employees. Trains, coaches, monitors, and manages the team's performance to meet or exceed company and department performance expectations.
Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure.
Ensures compliance with Contractual and Regulatory requirements.
Addresses more complex member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
Provides exemplary customer service to customers including members, co-workers, vendors, providers, government agencies, business partners, and general public.
Achieves individual performance goals as it relates to call center objectives.
Demonstrates personal responsibility and accountability and leads by example through individual performance.
Support projects and special initiatives as appropriate.
Proficient in Medicaid (CA Medicaid preferred), Medicare, and/or MMP lines of business
Ability to manage multiple requests, strong follow-through skills and ability to resolve issues in a fast-paced environment.
Excellent verbal and written communication.
Bilingual skills (fluent in English and Spanish) are a plus
JOB QUALIFICATIONS
Required Education
Associate degree or equivalent combination of education and experience
Required Experience
3-5 years' experience in a healthcare call center environment
1-2 years supervisory experience
Preferred Education
Bachelor's Degree or equivalent combination of education and experience
Preferred Experience
5-7 years
Pay Range: $41,264 - $80,464 yearly*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
#PJCC3
JOB DESCRIPTION
Job Summary
Provides customer support and stellar service to meet the needs of our Molina members and providers.
Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information and identifies opportunities to improve our member and provider experiences.
KNOWLEDGE/SKILLS/ABILITIES
Manages member services operations.
Ensures compliance with state and regulatory requirements.
Identifies new opportunities for process development.
Develops and implements interventions to address deficiencies and negative trends.
Provides exemplary customer service to customers including members, co-workers, vendors, providers, government agencies, business partners, and the general public.
Work with coworkers, management, and other departments to help coordinate problem solving in an effective and timely manner.
Provide technical expertise to co-workers and handles elevated calls
Provide exemplary customer service to customers including members, co-workers, vendors, providers, government agencies, business partners, and general public
Assists agents with questions and escalated calls. Recognizes trends and patterns in call types and engages leadership with suggested solutions.
Achieves individual performance goals as it relates to call center objectives.
Assists with training needs of employees as needed.
Demonstrates personal responsibility and accountability by meeting attendance and schedule adherence expectations.
Proficient in Medicaid (CA Medicaid preferred), Medicare, and/or MMP lines of business
Ability to manage multiple requests, strong follow-through skills and ability to resolve issues in a fast-paced environment.
Excellent verbal and written communication.
Bilingual skills (fluent in English and Spanish) are a plus
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
5-7 years
Experience in a Healthcare call center environment
Preferred Education
Graduate Degree or equivalent combination of education and experience
Preferred Experience
7-9 years
Pay Range: $54,922 - $107,098 yearly*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
#PJCC
JOB DESCRIPTION
Job Summary
Provides customer support and stellar service to meet the needs of our Molina members and providers.
Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions.
Provides product and service information and identifies opportunities to improve our member and provider experiences.
KNOWLEDGE/SKILLS/ABILITIES
Supervises a team of employees. Trains, coaches, monitors, and manages the team's performance to meet or exceed company and department performance expectations.
Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure.
Ensures compliance with Contractual and Regulatory requirements.
Addresses more complex member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
Provides exemplary customer service to customers including members, co-workers, vendors, providers, government agencies, business partners, and general public.
Achieves individual performance goals as it relates to call center objectives.
Demonstrates personal responsibility and accountability and leads by example through individual performance.
Support projects and special initiatives as appropriate.
Proficient in Medicaid (CA Medicaid preferred), Medicare, and/or MMP lines of business
Ability to manage multiple requests, strong follow-through skills and ability to resolve issues in a fast-paced environment.
Excellent verbal and written communication.
Bilingual skills (fluent in English and Spanish) are a plus
Direct Provider Experience, Claims/A&G experience is a plus
JOB QUALIFICATIONS
Required Education
Associate degree or equivalent combination of education and experience
Required Experience
3-5 years' experience in a healthcare call center environment
1-2 years supervisory experience
Preferred Education
Bachelor's Degree or equivalent combination of education and experience
Preferred Experience
5-7 years
Pay Range: $41,264 - $80,464 yearly*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
#PJCC2
JOB DESCRIPTION
Case Manager opportunity in the Champaign, IL service area available for either an IL licensed LPN or a Bachelors trained social service candidate. Meeting with members in their homes for a face-to-face visit is part of the expectations of the role; mileage is reimbursed as part of our benefits package. Schedule is Monday - Friday, 8AM - 5PM. Applicants with experience in Case Management are preferred.
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).
Pay Range: $24.00 - 46.81 per hour*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
Molina Healthcare is hiring for several Peer Support Specialists (Mental Health and/or Substance Use Disorders) in Nebraska.
Peer Support Specialists will ideally be those who have a shared experience in either Mental Health (MH) or Substance Use Disorders (SUD) and have been successful in the recovery process who can help others experiencing similar situations. These roles will inspire hope that people can and do recover; walk with people on their recovery journeys; dispel myths about what it means to have a mental health condition or substance use disorder.
This role will work closely with the SUD Navigator and other departments to help engage our members in a range of activities and interactions along with provide self-help education and link people to tools and resources; and support people in identifying their goals, hopes, and dreams, and creating a roadmap for getting there.
This is a field-based role where you will be meeting with members in the community. You can expect to be in the field 75% of the time or more (Molina reimburses mileage).
Highly qualified candidates will have the following experience-
Completion of the state of Nebraska's Peer Support Core Curriculum and/or be a Certified Peer Support Specialist - CPSS
Provides peer support services for members with behavioral health issues, psychiatric disorders, drug and/or alcohol dependence, and physical illnesses.
Must have a clear and valid drivers license and reliable vehicle
Have the ability and desire to meet with members in the community.
Experience working in a psychiatric unit or facility.
Understands they will serve as a consumer advocate by providing consumer information, resources, and peer support for clients in outpatient and inpatient settings.
Will assist members in setting and pursuing their own recovery goals and in working with their case managers and/or treatment team to determine the steps needed to achieve these goals.
Will have 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. Experience with electronic records, Excel, Word, MS Outlook needed. This is a fast-paced position. Local travel in within the assigned region is required. FREQUENT TRAVEL in the field to do member visits in the surrounding areas will be required
#LI-TR1
JOB QUALIFICATIONS
Required Education : Min. High School diploma or GED.
Preferred Education : Graduate of a two- or four-year allied Health Program
Required Experience: Managed Care exposure and knowledge of community resources; knowledge of HIPAA and confidentiality rules.
Preferred Experience : Experience in psychiatric unit or facility a plus but not necessary.
Required License, Certification, Association : Valid State Driver's License with proof of insurance.
Preferred License, Certification, Association : Active and unrestricted Certified Peer Specialist
Pay Range: $14.16 to $27.61 per hour* *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Key Words: CPSS, Certified Peer Support Specialist, CPS, Certified Peer Support, Peer Support, Peer Support Specialist, Support, Substance Abuse, Mental Health, Psychiatric, Community Connector, Residential, Recovery, Rapport, Intervention, Behavioral Health, Social Worker, Specialized Care Unit, Nonclinical Case Manager, Care Manager, Community Engagement, Public Health, Healthcare, Health Care, Managed Care, MCO, Medicaid, Medicare, community health advisor, family advocate, advocacy, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter, public health aide, community lead, community advocate, nonprofit, non-profit, social worker, case worker, housing counselor, human service worker, Navigator, Assistor, Connecter, Promotora, Marketing, managed care, MCO, education, educating, resource, wellness recovery action plans (WRAP) and Whole Health Action Management (WHAM)
Molina Healthcare is hiring for several Peer Support Specialists (Mental Health and/or Substance Use Disorders) in Nebraska.
Peer Support Specialists will ideally be those who have a shared experience in either Mental Health (MH) or Substance Use Disorders (SUD) and have been successful in the recovery process who can help others experiencing similar situations. These roles will inspire hope that people can and do recover; walk with people on their recovery journeys; dispel myths about what it means to have a mental health condition or substance use disorder.
This role will work closely with the SUD Navigator and other departments to help engage our members in a range of activities and interactions along with provide self-help education and link people to tools and resources; and support people in identifying their goals, hopes, and dreams, and creating a roadmap for getting there.
This is a field-based role where you will be meeting with members in the community. You can expect to be in the field 75% of the time or more (Molina reimburses mileage).
Highly qualified candidates will have the following experience-
Completion of the state of Nebraska's Peer Support Core Curriculum and/or be a Certified Peer Support Specialist - CPSS
Provides peer support services for members with behavioral health issues, psychiatric disorders, drug and/or alcohol dependence, and physical illnesses.
Must have a clear and valid drivers license and reliable vehicle
Have the ability and desire to meet with members in the community.
Experience working in a psychiatric unit or facility.
Understands they will serve as a consumer advocate by providing consumer information, resources, and peer support for clients in outpatient and inpatient settings.
Will assist members in setting and pursuing their own recovery goals and in working with their case managers and/or treatment team to determine the steps needed to achieve these goals.
Will have 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. Experience with electronic records, Excel, Word, MS Outlook needed. This is a fast-paced position. Local travel in within the assigned region is required. FREQUENT TRAVEL in the field to do member visits in the surrounding areas will be required
#LI-TR1
JOB QUALIFICATIONS
Required Education : Min. High School diploma or GED.
Preferred Education : Graduate of a two- or four-year allied Health Program
Required Experience: Managed Care exposure and knowledge of community resources; knowledge of HIPAA and confidentiality rules.
Preferred Experience : Experience in psychiatric unit or facility a plus but not necessary.
Required License, Certification, Association : Valid State Driver's License with proof of insurance.
Preferred License, Certification, Association : Active and unrestricted Certified Peer Specialist
Pay Range: $14.16 to $27.61 per hour* *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Key Words: CPSS, Certified Peer Support Specialist, CPS, Certified Peer Support, Peer Support, Peer Support Specialist, Support, Substance Abuse, Mental Health, Psychiatric, Community Connector, Residential, Recovery, Rapport, Intervention, Behavioral Health, Social Worker, Specialized Care Unit, Nonclinical Case Manager, Care Manager, Community Engagement, Public Health, Healthcare, Health Care, Managed Care, MCO, Medicaid, Medicare, community health advisor, family advocate, advocacy, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter, public health aide, community lead, community advocate, nonprofit, non-profit, social worker, case worker, housing counselor, human service worker, Navigator, Assistor, Connecter, Promotora, Marketing, managed care, MCO, education, educating, resource, wellness recovery action plans (WRAP) and Whole Health Action Management (WHAM)
JOB DESCRIPTION
Opportunity for IL licensed LPN or Bachelors/Masters trained, experienced Case Manager to work for our Health Plan in Illinois. Meeting with members face-to-face in their homes is required for this position. Territory for this opportunity covers Boone, McHenry, DeKalb, Kane, Stephenson, Winnebago, Ogle, Lake, and Lee Counties. Work schedule of Monday - Friday, 8 AM - 5PM; mileage is reimbursed as part of our benefit package.
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.
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).
Pay Range: $24.00 - 46.81 per hour*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJHS
#LI-BEMORE
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.
Job Duties
The Mgr, Clinical Data Acquisition uses knowledge, skills and technical expertise to manage the mission critical nature of the performance measurement data collection, reporting and monitoring process, including HEDIS, state-based measure reporting and medical record review.
Manages annual HEDIS data collection activities. Responsibilities include responding to RFP(s) as needed, development of the HEDIS measures matrix, HEDIS work plans, and all product timelines.
Works with the Director to manage contacts within the plan(s) and/or Molina corporate, external auditors, software and medical record vendors, and other Molina departments, such as Claims, Enrollment, IT etc,. to get appropriate responses and manage contracts and projects as needed.
Works with corporate resources and relevant vendors to assure the soundness and correctness of data used to create HEDIS results. Manages state's annual CAHPS survey process and other organizational survey activities, such as the annual Provider Satisfaction Survey.
Ensures quality assurance is performed for generated reports including performance measurement rates.
Manages medical record review and performance measurement reporting projects for assigned area(s) ensuring timelines are met. Defines use of in-house vs. vendor strategy for each HEDIS season.
May implement improvement activities directly related to HEDIS and CAHPS processes; coordinates with appropriate departments and committees on others. Identifies and recommends potential clinical measurement and quality improvement activities.
Maximizes use of information from multiple sources, including claims/encounters, pharmacy, utilization management, clinical indicators, industry benchmark, and/or survey/vendor data.
Submits data to external agencies and quality committees within required timeframes.
JOB QUALIFICATIONS
REQUIRED EDUCATION:
Bachelor's Degree or equivalent work experience.
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
- 7+ years experience in managed healthcare Quality/HEDIS project management and HEDIS Audit
- Demonstrated knowledge of and experience with HEDIS programs.
- Proficiency with data manipulation and interpretation.
- Proficiency with Excel and Visio (flow chart equivalent) and demonstrated ability to learn new information systems and software programs.
PREFERRED EDUCATION:
Master's Degree or higher in a clinical field, Public Health or Healthcare.
PREFERRED EXPERIENCE:
- STARS improvement experience
- CAHPS improvement experience
- 3+ years health care information systems experience or in a role as an IS liaison/contact for QI projects.
- State QI experience
- Supervisory experience.
- Project management and team building experience.
- Experience developing performance measures that support business objectives.
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
- Certified Professional in Health Quality (CPHQ)
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: $73,102 - $142,549 a year*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.