Company Detail

Job Description

Job Description

Job Summary

Builds company specific systems and technology expertise across multiple infrastructure and development disciplines

Knowledge/Skills/Abilities

- Responsible for task management and adherence to process controls.

- Responsible for troubleshooting and incident resolution for support functions.

- Contributes to on-call rotation schedules and off-hour support activities.

- Contributes to organize, manage and lead cross-team project tasks and deliverables.

- Contributes to the Infrastructure Solution Architect project design function.

- Contributes to solution architecture delivery within project management methodologies and timelines.

- Contributes to root cause analysis and problem solving.

- Contributes to tactical build and configuration activities.

- Provides cross-organization teamwork, collaboration, communication and leadership.

- Provides constructive feedback on people, process and technology for continuous improvement..

Job Qualifications

Required Education

- Bachelor's Degree.

Required Experience

1-4 years of IT technical experience with IT enterprise infrastructure.

Industry certifications preferred.

Experience in design and management of cloud-based network infrastructure.

Experience in network administration and support in a Microsoft server environment.

Experience with configuring and maintaining network switches, VLANS, routers, and firewalls.

Experience working in a large very complex organization.

Preferred Experience

Experience working within a health care organization.

Experience in a help desk, technology-oriented field, or on a technology support team.

Knowledge of Software-Defined Network (SDWAN), Local Area Networks (LANs), Wireless Local Area Networks (WLANS), and Wide Area Networks (WANs).

Experience utilizing Cisco security suite/tools.

Experience with a Virtual Private Network (VPN), with network monitoring tools or other SNMP monitoring software, and with system backup.

Enterprise (global) AD administration in a Multi-Domain Architecture.

Certifications below or comparable in network, network security and engineering

CISSP (Certified Information System Security Professional)

CISM (Certified Information Security Manager)

MCSE (Microsoft Certified Solutions Expert)

CCNA (Cisco Certified Network Associate) or CCNP (Cisco Certified Network Professional)

Pay Range: $60,415 - $117,809 a 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.

#PJCorp

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

Builds company specific systems and technology expertise across multiple infrastructure and development disciplines

Knowledge/Skills/Abilities

- Responsible for task management and adherence to process controls.

- Responsible for troubleshooting and incident resolution for support functions.

- Contributes to on-call rotation schedules and off-hour support activities.

- Contributes to organize, manage and lead cross-team project tasks and deliverables.

- Contributes to the Infrastructure Solution Architect project design function.

- Contributes to solution architecture delivery within project management methodologies and timelines.

- Contributes to root cause analysis and problem solving.

- Contributes to tactical build and configuration activities.

- Provides cross-organization teamwork, collaboration, communication and leadership.

- Provides constructive feedback on people, process and technology for continuous improvement..

Job Qualifications

Required Education

- Bachelor's Degree.

Required Experience

1-4 years of IT technical experience with IT enterprise infrastructure.

Industry certifications preferred.

Experience in design and management of cloud-based network infrastructure.

Experience in network administration and support in a Microsoft server environment.

Experience with configuring and maintaining network switches, VLANS, routers, and firewalls.

Experience working in a large very complex organization.

Preferred Experience

Experience working within a health care organization.

Experience in a help desk, technology-oriented field, or on a technology support team.

Knowledge of Software-Defined Network (SDWAN), Local Area Networks (LANs), Wireless Local Area Networks (WLANS), and Wide Area Networks (WANs).

Experience utilizing Cisco security suite/tools.

Experience with a Virtual Private Network (VPN), with network monitoring tools or other SNMP monitoring software, and with system backup.

Enterprise (global) AD administration in a Multi-Domain Architecture.

Certifications below or comparable in network, network security and engineering

CISSP (Certified Information System Security Professional)

CISM (Certified Information Security Manager)

MCSE (Microsoft Certified Solutions Expert)

CCNA (Cisco Certified Network Associate) or CCNP (Cisco Certified Network Professional)

Pay Range: $60,415 - $117,809 a 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.

#PJCorp

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

Builds company specific systems and technology expertise across multiple infrastructure and development disciplines

Knowledge/Skills/Abilities

- Responsible for task management and adherence to process controls.

- Responsible for troubleshooting and incident resolution for support functions.

- Contributes to on-call rotation schedules and off-hour support activities.

- Contributes to organize, manage and lead cross-team project tasks and deliverables.

- Contributes to the Infrastructure Solution Architect project design function.

- Contributes to solution architecture delivery within project management methodologies and timelines.

- Contributes to root cause analysis and problem solving.

- Contributes to tactical build and configuration activities.

- Provides cross-organization teamwork, collaboration, communication and leadership.

- Provides constructive feedback on people, process and technology for continuous improvement..

Job Qualifications

Required Education

- Bachelor's Degree.

Required Experience

1-4 years of IT technical experience with IT enterprise infrastructure.

Industry certifications preferred.

Experience in design and management of cloud-based network infrastructure.

Experience in network administration and support in a Microsoft server environment.

Experience with configuring and maintaining network switches, VLANS, routers, and firewalls.

Experience working in a large very complex organization.

Preferred Experience

Experience working within a health care organization.

Experience in a help desk, technology-oriented field, or on a technology support team.

Knowledge of Software-Defined Network (SDWAN), Local Area Networks (LANs), Wireless Local Area Networks (WLANS), and Wide Area Networks (WANs).

Experience utilizing Cisco security suite/tools.

Experience with a Virtual Private Network (VPN), with network monitoring tools or other SNMP monitoring software, and with system backup.

Enterprise (global) AD administration in a Multi-Domain Architecture.

Certifications below or comparable in network, network security and engineering

CISSP (Certified Information System Security Professional)

CISM (Certified Information Security Manager)

MCSE (Microsoft Certified Solutions Expert)

CCNA (Cisco Certified Network Associate) or CCNP (Cisco Certified Network Professional)

Pay Range: $60,415 - $117,809 a 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.

#PJCorp

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

My Choice Wisconsin under Molina Healthcare 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.

• This is a Partnership program.

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.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

My Choice Wisconsin under Molina Healthcare 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.

• This is a Family Care program.

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.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This position will offer remote work flexibility, however, the ideal candidate will reside in Iowa.

Job Summary

Analyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Uses comprehensive background to navigate analytical problems, including clearly defining and documenting their unique specifications.

• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

• Responsible for developing appropriate methodologies and preparation of weekly reports.

• Encourages cooperative interactions between cross functional teammates.

• Coordinates work of other business data analysts and provides training to subordinates/team members.

• Leverages expertise to review, research, analyze and evaluate all data relating to specific area of expertise.

• Actively leads in all stages of project development including research, design, programming, testing and implementation to ensures the released product meets the intended functional and operational requirements

• Uses mastery of subject matter to guide communication and collaboration with external and internal customers by analyzing their needs and goals.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

• 7+ years of business analysis experience,

• 6+ years managed care experience.

• Demonstrates expertise in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

• 7-9 years project manager experience

• Experience working with complex, often highly technical teams.

Preferred License, Certification, Association

Certified Business Analysis Professional (CBAP), Certification from International Institute of Business Analysis preferred

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

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

Pay Range: $66,456 - $129,590 a year*

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

Job Detail

• Company:
  Molina Healthcare

Job Description

*Remote and must live in Iowa*

Job Description

Job Summary

Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

Job Duties

This role serves as the primary point of contact between Molina Health plan and the Plan's Complex Provider Community that services Molina members, including but not limited to Value Based Payment and other Alternative Payment Method contracts. It is an external-facing, field-based position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage complex providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.

- Under general supervision, works directly with the Plan's external complex providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service.

- Resolves complex provider issues that may cross departmental lines including Contracting, Finance, Quality, Operations, and involve Senior Leadership.

- Responsible for Provider Satisfaction survey results.

- Develops and deploys strategic network planning tools to drive Provider Relations and Contracting Strategy across the enterprise.

- Facilitates strategic planning and documentation of network management standards and processes. Effectiveness is tied to financial and quality indicators.

- Works collaboratively with functional business unit stakeholders to lead and/or support various provider services functions with an emphasis on developing and implementing standards and best practices sharing across the organization.

- MCST matrix team environmental support including, but not limited to: New Markets Provider/Contract Support Services, PCRP & CSST resolution support, and National Contract Management support services.

- Serves as a subject matter expert for other departments.

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

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

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

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

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

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

- Trains other Provider Relations Representatives as appropriate.

- Role requires 60%+ same-day or overnight travel. (Extent of same-day or overnight travel will depend on the specific Health Plan and its service area.)

Job Qualifications

REQUIRED EDUCATION :

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

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

- 4-6 years provider contract network relations and management experience in a managed healthcare setting.

- Working experience servicing complex providers with various managed healthcare provider compensation methodologies, including but not limited to: fee-for service, value-based contracts, capitation and various forms of risk, ASO, etc.

PREFERRED EDUCATION :

Master's Degree in Health or Business related field

PREFERRED EXPERIENCE :

- 5 years experience in managed healthcare administration.

- Specific experience in provider services, operations, and/or contract negotiations in a Medicare and Medicaid managed healthcare setting, ideally with different provider types (e.g., physician, groups and hospitals).

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

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

Pay Range: $60,415 - $117,809 a year*

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

#PJCorp

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

*Remote and must live in Iowa*

Job Description

Job Summary

Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

Job Duties

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

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

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

- Serves as a subject matter expert for other departments.

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

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

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

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

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

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

- Trains other Provider Relations Representatives as appropriate.

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

Job Qualifications

REQUIRED EDUCATION :

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

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

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

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

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

PREFERRED EXPERIENCE :

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

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

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

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

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

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

#PJCorp2

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This position will offer remote work flexibility, however, the ideal candidate will reside in Iowa.

Job Summary

Analyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Uses comprehensive background to navigate analytical problems, including clearly defining and documenting their unique specifications.

• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

• Responsible for developing appropriate methodologies and preparation of weekly reports.

• Encourages cooperative interactions between cross functional teammates.

• Coordinates work of other business data analysts and provides training to subordinates/team members.

• Leverages expertise to review, research, analyze and evaluate all data relating to specific area of expertise.

• Actively leads in all stages of project development including research, design, programming, testing and implementation to ensures the released product meets the intended functional and operational requirements

• Uses mastery of subject matter to guide communication and collaboration with external and internal customers by analyzing their needs and goals.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

• 7+ years of business analysis experience,

• 6+ years managed care experience.

• Demonstrates expertise in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

• 7-9 years project manager experience

• Experience working with complex, often highly technical teams.

Preferred License, Certification, Association

Certified Business Analysis Professional (CBAP), Certification from International Institute of Business Analysis preferred

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

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

Pay Range: $66,456 - $129,590 a year*

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

This position will offer remote work flexibility, however, the ideal candidate will reside in Iowa.

Job Summary

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

Job Duties

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

• Plans and directs schedules as well as project budgets.

• Monitors the project from inception through delivery.

• May engage and oversee the work of external vendors.

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

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

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

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

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

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

• Generate and distribute standard reports on schedule

JOB QUALIFICATIONS

REQUIRED EDUCATION :

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

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

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

• Operational Process Improvement experience.

• Healthcare experience.

• Experience with Microsoft Project and Visio.

• Excellent presentation and communication skills.

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

PREFERRED EDUCATION :

Graduate Degree or equivalent combination of education and experience.

PREFERRED EXPERIENCE :

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

- Managed Care experience.

- Experience working in a cross functional highly matrixed organization.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :

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

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

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

Pay Range: $66,456 - $129,590 a year*

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

This position will offer remote work flexibility, however, the ideal candidate will reside in Iowa.

Job Summary

Collects, validates, analyzes, and organizes data into meaningful reports for management decision making. Leads analytics by designing, developing, testing and deploying reports to leadership and other end users for operational, strategic, and goal tracking analysis.

Job Duties

Leads and provides indirect oversight of Healthcare Reporting Team activities and personnel. Provides technical expertise to the team and manages relationships with operational leaders and staff. Provides analysis and estimates on steady state and future requests. Resource to staff for mentoring, coaching, and analysis questions. Responsible for new report development, maintenance and enhancements of existing reports, ADHOC reporting, and delivering analytical insights based on the reporting that was developed.

• Ability to make derive actionable insights with available data sources which may require a combination of server based automation and desktop processing

• Creates stored procedures, views, functions and queries

• Writes and maintains database stored procedures, functions and queries

• Acquires overall understanding of Growth Operations needs

• Establishes documentation for best practices, lessons learned, and DDI documents

• Provides peer review and unit test scripts.

• May work independently or cooperatively with other software developers, often assuming technical and project leadership roles.

• May function as a technical consultant or researcher.

• Highly proficient in SQL, Power BI, and Excel

• Leads in gathering requirements, technical requirements and works directly with Business Leader and IT

• Initiate and maintain cross-team relationships

Job Qualifications

REQUIRED EDUCATION:

- Bachelor's Degree in Finance, Economics, Math, Computer Science, Information Systems, Anaytics or related field

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• Expert in SSIS, Power BI, SQL

• Direct or indirect experience leading analytics teams

• Ability to mentor, coach, and train the team on technical asks

• Data Marts/Data warehouse building experience a plus

• Experience with Azure data lakes is a plus

• Salesforce.com / CRM Knowledge

• Process automation experience

• Strong analytical, technical, and interpersonal skills

• Strong leadership capabilities

• Must be highly motivated and results-oriented

• 5 years increasingly complex database and data management responsibilities, including compiling data, creating reports and displaying information

• 3-plus years managed care experience, preferably working with the Medicare/Medicaid product

• Knowledge of state encounter submission process.

• Knowledge of various SQL Servers and tools such as MS SSRS, Impala, Toad

PREFERRED EDUCATION:

- Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems or related field.

PREFERRED EXPERIENCE:

2-5 years of direct or indirect leadership experience

PHYSICAL DEMANDS:

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

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

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

Pay Range: $73,102 - $142,549 a year*

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

Job Detail

• Company:
  Molina Healthcare

Job Description

*Remote and must live in Michigan*

Job Description

Job Summary

Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

Job Duties

This role serves as partner to the Provider Contracting and Provider Relations Team in regards to receiving, researching and responding to provider inquiries. It is internal and external facing position requiring job knowledge to resolve basic provider inquiries and communication skills to successfully engage with providers and maintain provider satisfaction primarily for non-complex Providers including but not limited to Fee-For-Service and Pay for Performance Providers.

- Receives, researches, and resolves provider inquiries such as claims, eligibility, and other inquiries. Act as a liaison between the providers, medical groups and health plan.

- Duties may include: (a) Price specific services based on the Plan's fee schedule; (b) Communicate and educate providers on important changes to regulations, procedures and access to information; (c) Assist Providers in dismissing or moving members incorrectly assigned to them; and/or (d) Educate providers so the appropriate dismissal letters are sent to Molina members.

- Supports other members of the Provider Services Team when they are in the field.

- Responsible for documenting requests as required in departmental procedures.

- Assists with training of new Provider Services staff members, including orientations, website navigation and education.

- Attends off-site meetings when necessary with medical groups and other providers as needed.

- Performs Mailbox Support .

- Complies with required workplace safety standards.

Job Qualifications

REQUIRED EDUCATION :

High School Diploma or equivalent GED

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

1 year customer service, provider service, or claims experience in a managed care or medical office setting.

PREFERRED EDUCATION :

Associate's Degree

Vocational program in Managed Care or some other health care aspect providing a certificate at completion.

PREFERRED EXPERIENCE :

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

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: $16.40 - $31.97 an hour*

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

#PJCorp

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

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

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

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

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

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

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

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

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

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

• Responsible to maintain confidentiality and HIPPA compliance.

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

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

JOB QUALIFICATIONS

Required Education

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

Required Experience

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

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

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

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

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

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

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

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

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

Required License, Certification, Association

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

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

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

Pay Range: $18.04/hr - $35.17/hr*

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

Job Detail

• Company:
  Molina Healthcare

Job Description

*Remote and must live in Central Ohio and will travel 25% for provider visits*

Job Description

Job Summary

Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

Job Duties

This role serves as the primary point of contact between Molina Health plan and the for non-complex Provider Community that services Molina members, including but not limited to Fee-For-Service and Pay for Performance Providers. It is an external-facing, field-based position requiring a high degree of job knowledge, communication and organizational skills to successfully engage high volume, high visibility providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.

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

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

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

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

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

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

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

- Trains other Provider Relations Representatives as appropriate.

- Role requires 60%+ same-day or overnight travel. (Extent of same-day or overnight travel will depend on the specific Health Plan and its service area.)

Job Qualifications

REQUIRED EDUCATION :

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

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

- 2 - 3 years customer service, provider service, or claims experience in a managed care setting.

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

PREFERRED EDUCATION :

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

PREFERRED EXPERIENCE :

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

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

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

Pay Range: $19.84 - $38.69 an hour*

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

#PJCorp

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

*Remote and must live in Mississippi*

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: $73,102 - $142,549 a year*

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

#PJCore

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

This position will support our Senior Whole Health business. Senior Whole Health by Molina is a Managed Long-Term Care (MLTC), 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 Case Managers with Long-term Services and Supports (LTSS) experience, strong organizational and time management skills. The Case Manager must be able to manage remote work in a fast paced environment. Experience with homecare (CDPAS/PCA/PCS), Medicaid, food stamp, housing benefits within a medical model is highly preferred. This team works with a diverse population which included the geriatric, BH, and pediatric population.

This is a remote position providing support within the five boroughs and extended area (New Jersey, CT)

Work hours are Monday through Friday 8:30am - 5:00pm EST.

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

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

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

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

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

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

• Required License, Certification, Association

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

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

• New York RN licensure

State Specific Requirements

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

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

• Bilingual: Spanish

• Experience with homecare (CDPAS/PCA/PCS), Medicaid, food stamp, housing benefits

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

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 Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

This position will support our Senior Whole Health business. Senior Whole Health by Molina is a Managed Long-Term Care (MLTC), 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 Case Managers with Long-term Services and Supports (LTSS) experience, strong organizational and time management skills. The Case Manager must be able to manage remote work in a fast paced environment. Experience with homecare (CDPAS/PCA/PCS), Medicaid, food stamp, housing benefits within a medical model is highly preferred. This team works with a diverse population which included the geriatric, BH, and pediatric population. LCSW or LMSW licensure is required.

This is a remote position providing support within the five boroughs and extended area (New Jersey, CT)

Work hours are Monday through Friday 8:30am - 5:00pm EST.

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

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

REQUIRED EXPERIENCE:

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

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

PREFERRED EXPERIENCE:

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

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

• LMSW or LCSW licensure

• Bilingual: Spanish

• Experience with homecare (CDPAS/PCA/PCS), Medicaid, food stamp, housing benefits

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

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

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

Pay Range: $24.00 - $46.81 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 Detail

• Company:
  Molina Healthcare

Job Description

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.

*Based in Michigan*

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 (MI) 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).

Pay Range: $246,251 - $480,190 a 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.

#PJHPO

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

*Remote and must live in Michigan*

Job Description

Job Summary

Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

Job Duties

This role serves as partner to the Provider Contracting and Provider Relations Team in regards to receiving, researching and responding to provider inquiries. It is internal and external facing position requiring job knowledge to resolve basic provider inquiries and communication skills to successfully engage with providers and maintain provider satisfaction primarily for non-complex Providers including but not limited to Fee-For-Service and Pay for Performance Providers.

- Receives, researches, and resolves provider inquiries such as claims, eligibility, and other inquiries. Act as a liaison between the providers, medical groups and health plan.

- Duties may include: (a) Price specific services based on the Plan's fee schedule; (b) Communicate and educate providers on important changes to regulations, procedures and access to information; (c) Assist Providers in dismissing or moving members incorrectly assigned to them; and/or (d) Educate providers so the appropriate dismissal letters are sent to Molina members.

- Supports other members of the Provider Services Team when they are in the field.

- Responsible for documenting requests as required in departmental procedures.

- Assists with training of new Provider Services staff members, including orientations, website navigation and education.

- Attends off-site meetings when necessary with medical groups and other providers as needed.

- Performs Mailbox Support .

- Complies with required workplace safety standards.

Job Qualifications

REQUIRED EDUCATION :

High School Diploma or equivalent GED

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

1 year customer service, provider service, or claims experience in a managed care or medical office setting.

PREFERRED EDUCATION :

Associate's Degree

Vocational program in Managed Care or some other health care aspect providing a certificate at completion.

PREFERRED EXPERIENCE :

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

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: $16.40 - $31.97 an hour*

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

#PJCorp

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

*Remote and must live in Michigan*

Job Description

Job Summary

Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

Job Duties

This role serves as partner to the Provider Contracting and Provider Relations Team in regards to receiving, researching and responding to provider inquiries. It is internal and external facing position requiring job knowledge to resolve basic provider inquiries and communication skills to successfully engage with providers and maintain provider satisfaction primarily for non-complex Providers including but not limited to Fee-For-Service and Pay for Performance Providers.

- Receives, researches, and resolves provider inquiries such as claims, eligibility, and other inquiries. Act as a liaison between the providers, medical groups and health plan.

- Duties may include: (a) Price specific services based on the Plan's fee schedule; (b) Communicate and educate providers on important changes to regulations, procedures and access to information; (c) Assist Providers in dismissing or moving members incorrectly assigned to them; and/or (d) Educate providers so the appropriate dismissal letters are sent to Molina members.

- Supports other members of the Provider Services Team when they are in the field.

- Responsible for documenting requests as required in departmental procedures.

- Assists with training of new Provider Services staff members, including orientations, website navigation and education.

- Attends off-site meetings when necessary with medical groups and other providers as needed.

- Performs Mailbox Support .

- Complies with required workplace safety standards.

Job Qualifications

REQUIRED EDUCATION :

High School Diploma or equivalent GED

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

1 year customer service, provider service, or claims experience in a managed care or medical office setting.

PREFERRED EDUCATION :

Associate's Degree

Vocational program in Managed Care or some other health care aspect providing a certificate at completion.

PREFERRED EXPERIENCE :

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

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: $16.40 - $31.97 an hour*

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

#PJCorp

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provisions of medical staff services. Maintains a working knowledge of applicable national, state, and local laws and regulatory requirements affecting the medical and clinical staff.

Job Duties

• Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management.

• Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership position relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity.

• Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality improvement staff.

• Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements.

• Reviews quality referred issues, focused reviews and recommends corrective actions.

• Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.

• Attends or chairs committees as required such as Credentialing, P&T and others as directed by the Chief Medical Officer.

• Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the denial process.

• Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care.

• Ensures that medical decisions are rendered by qualified medical personnel, not influenced by fiscal or administrative management considerations, and that the care provided meets the standards for acceptable medical care.

• Ensures that medical protocols and rules of conduct for plan medical personnel are followed.

• Develops and implements plan medical policies.

• Provides implementation support for Quality Improvement activities.

• Stabilizes, improves and educates the Primary Care Physician and Specialty networks. Monitors practitioner practice patterns and recommends corrective actions if needed.

• Fosters Clinical Practice Guideline implementation and evidence-based medical practice.

• Utilizes IT and data analysts to produce tools to report, monitor and improve Utilization Management.

• Actively participates in regulatory, professional and community activities.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Doctorate Degree in Medicine

• Board Certified or eligible in a primary care specialty

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 3+ years relevant experience, including:

• 2 years previous experience as a Medical Director in a clinical practice.

• Current clinical knowledge.

• Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.

• Knowledge of applicable state, federal and third party regulations

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

Current state (VA) Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.

PREFERRED EDUCATION:

Master's in Business Administration, Public Health, Healthcare Administration, etc.

PREFERRED EXPERIENCE:

• Peer Review, medical policy/procedure development, provider contracting experience.

• Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.

• Experience in Utilization/Quality Program management

• HMO/Managed care experience

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Board Certification (Primary Care preferred).

PHYSICAL DEMANDS:

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

Pay Range: $161,914.25 - $315,732.79 a 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.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provisions of medical staff services. Maintains a working knowledge of applicable national, state, and local laws and regulatory requirements affecting the medical and clinical staff.

Job Duties

• Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management.

• Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership position relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity.

• Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality improvement staff.

• Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements.

• Reviews quality referred issues, focused reviews and recommends corrective actions.

• Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.

• Attends or chairs committees as required such as Credentialing, P&T and others as directed by the Chief Medical Officer.

• Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the denial process.

• Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care.

• Ensures that medical decisions are rendered by qualified medical personnel, not influenced by fiscal or administrative management considerations, and that the care provided meets the standards for acceptable medical care.

• Ensures that medical protocols and rules of conduct for plan medical personnel are followed.

• Develops and implements plan medical policies.

• Provides implementation support for Quality Improvement activities.

• Stabilizes, improves and educates the Primary Care Physician and Specialty networks. Monitors practitioner practice patterns and recommends corrective actions if needed.

• Fosters Clinical Practice Guideline implementation and evidence-based medical practice.

• Utilizes IT and data analysts to produce tools to report, monitor and improve Utilization Management.

• Actively participates in regulatory, professional and community activities.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Doctorate Degree in Medicine

• Board Certified or eligible in a primary care specialty

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 3+ years relevant experience, including:

• 2 years previous experience as a Medical Director in a clinical practice.

• Current clinical knowledge.

• Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.

• Knowledge of applicable state, federal and third party regulations

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

Current state (VA) Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.

PREFERRED EDUCATION:

Master's in Business Administration, Public Health, Healthcare Administration, etc.

PREFERRED EXPERIENCE:

• Peer Review, medical policy/procedure development, provider contracting experience.

• Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.

• Experience in Utilization/Quality Program management

• HMO/Managed care experience

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Board Certification (Primary Care preferred).

PHYSICAL DEMANDS:

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

Pay Range: $161,914.25 - $315,732.79 a 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.

Job Detail

• Company:
  Molina Healthcare

Job Description

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.

*Based in Michigan*

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 (MI) 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).

Pay Range: $246,251 - $480,190 a 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.

#PJHPO

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare is hiring for a Community Connector in Northern Iowa.

This position serves as a member advocate and resource connector, using knowledge of the community and resources to engage and assist members in managing their healthcare needs.

You will collaborate with, and support the Healthcare Services team by providing non-clinical paraprofessional duties, including but not limited to, helping to complete annual paperwork, help direct and connect to resources, getting calls out to complete required screenings, etc.

This important and critical role empowers members by helping them navigate and maximize their health plan benefits.

This role will be a hybrid position where you will be mostly working remotely, however you must be available to see members in the community approximately two days per week. An active Drivers License and reliable vehicle is required.

Highly qualified candidates will have the following:

• Live in Northern Iowa

• Be highly customer centric with great communication skills, both written and verbal.

• Able and willing to meet with/work with members face to face.

• Experience in healthcare, home health, medical assisting, etc. Highly preferred is experience with Medicare, Medicaid, Managed Care,

• Must be familiar with MS Word and Excel. Above average computer skills needed as you will need to be able to navigate different computer systems.

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

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

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

• Local travel may be required. Reliable transportation and valid driver's license required.

• #LI-TR1

REQUIRED EDUCATION: HS Diploma/GED

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

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

PREFERRED EXPERIENCE:

• Bilingual based on community need.

• Familiarity with healthcare systems a plus.

• Knowledge of community-specific culture.

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

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

• Active and unrestricted Medical Assistant Certification

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

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

Pay Range: $15.58 to $30.37 per hour* *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Key Words: Community Connector, Nonclinical Case Manager, Care Manager, Community Engagement, Public Health, Healthcare, Health Care, Managed Care, MCO, Medicaid, Medicare, HEDIS, CAPHS, equity community health advisor, family advocate, advocacy, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter, public health aide, community lead, community advocate, nonprofit, non-profit, social worker, case worker, housing counselor, human service worker, Navigator, Assistor, Connecter, Promotora, Marketing, managed care, MCO, member, market, screening, education, educating, resource

Job Detail

• Company:
  Molina Healthcare

Job Description

Molina Healthcare is hiring for a Community Connector in Northern Iowa.

This position serves as a member advocate and resource connector, using knowledge of the community and resources to engage and assist members in managing their healthcare needs.

You will collaborate with, and support the Healthcare Services team by providing non-clinical paraprofessional duties, including but not limited to, helping to complete annual paperwork, help direct and connect to resources, getting calls out to complete required screenings, etc.

This important and critical role empowers members by helping them navigate and maximize their health plan benefits.

This role will be a hybrid position where you will be mostly working remotely, however you must be available to see members in the community approximately two days per week. An active Drivers License and reliable vehicle is required.

Highly qualified candidates will have the following:

• Live in Northern Iowa

• Be highly customer centric with great communication skills, both written and verbal.

• Able and willing to meet with/work with members face to face.

• Experience in healthcare, home health, medical assisting, etc. Highly preferred is experience with Medicare, Medicaid, Managed Care,

• Must be familiar with MS Word and Excel. Above average computer skills needed as you will need to be able to navigate different computer systems.

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

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

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

• Local travel may be required. Reliable transportation and valid driver's license required.

• #LI-TR1

REQUIRED EDUCATION: HS Diploma/GED

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

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

PREFERRED EXPERIENCE:

• Bilingual based on community need.

• Familiarity with healthcare systems a plus.

• Knowledge of community-specific culture.

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

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

• Active and unrestricted Medical Assistant Certification

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

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

Pay Range: $15.58 to $30.37 per hour* *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Key Words: Community Connector, Nonclinical Case Manager, Care Manager, Community Engagement, Public Health, Healthcare, Health Care, Managed Care, MCO, Medicaid, Medicare, HEDIS, CAPHS, equity community health advisor, family advocate, advocacy, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter, public health aide, community lead, community advocate, nonprofit, non-profit, social worker, case worker, housing counselor, human service worker, Navigator, Assistor, Connecter, Promotora, Marketing, managed care, MCO, member, market, screening, education, educating, resource

Job Detail

• Company:
  Molina Healthcare