Company Detail

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

• Assists with all incoming calls and assist perspective members or members with health access related questions.

• Identify partnerships with key sponsorship opportunities and provide justification to determine Molina's participation.

• Identify and promote Molina's programs out in the community and creates opportunities for employees to participate.

• Responsible for managing their own daily schedule in alignment with department goals and initiatives as assigned by regions.

• Key in the development of SMART goals and provide input on department priorities.

JOB QUALIFICATIONS

Required Education:

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

Required Experience:

• Min. 3 years of related experience (e.g., marketing, business development, community engagement, healthcare industry).

• Demonstrated exceptional networking and negotiations skills.

• Demonstrated strong public speaking and presentations skills.

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

• Must be able to attend public events in outdoor venues in all weather conditions.

• Must be able to sit and stand for long periods.

• Must be able to drive up to 3 hours to attend events. Must be able to lift 30 pounds.

Required License, Certification, Association:

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

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

Preferred Education:

• Bachelor's Degree in Marketing or related discipline.

Preferred Experience:

• Solid understanding of Health Care Markets, primarily Medicaid.

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

• 5 years of outreach experience serving low-income populations.

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

• Experience presenting to influencer and low-income audiences.

• Experience in sales or marketing techniques.

• Fluency in a second language highly desirable.

Preferred License, Certification, Association:

• Active Life & Health Insurance

• Market Place Certified

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

For this position we are seeking a (RN) Registered Nurse who lives in MISSISSIPPI and must be licensed for the state of MISSISSIPPI. We are seeking RN's, who must live in either Northern or Southern Mississippi and must be licensed for the state of MS. Transition of Care RN will work with Medicaid population assisting with transition from hospital to next level of care. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members and providers on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important.

Home office with internet connectivity of high speed required.

Field Travel in the field to local hospitals, homes, and clinics. minimum of 35 Field visits a month. Mileage will be reimbursed.

(Southern MS - Hattiesburg to Coastal Areas)

Schedule: Monday thru Friday 8:00AM to 5:00PM. (No Weekends or Holidays)

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

• Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required.

• Works with participating ancillary providers, public agencies, or other service providers to make sure necessary services and equipment are in place for a safe transition.

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

• Coordinates care and reassesses member's needs using the Coleman Care Transitions Model recommended post-discharge timeline.

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

• RNs provide consultation, recommendations, and education as appropriate to non-RN case managers.

• RNs are assigned cases with members who have complex medical conditions and medication regimens.

• RNs will conduct medication reconciliation when needed.

• 40-50% local travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

1-3 years hospital discharge planning or home health.

Required License, Certification, Association

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

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

3-5 years hospital discharge planning or home health.

Preferred License, Certification, Association

Active, unrestricted Transitions of Care Sub-Specialty Certification and/or Certified Case Manager (CCM)

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

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

Pay Range: $26.41 - $51.49 an hour*

*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

For this position we are seeking a (RN) Registered Nurse who lives in MISSISSIPPI and must be licensed for the state of MISSISSIPPI. We are seeking RN's, who must live in either Northern or Southern Mississippi and must be licensed for the state of MS. Transition of Care RN will work with Medicaid population assisting with transition from hospital to next level of care. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members and providers on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important.

Home office with internet connectivity of high speed required.

Field Travel in the field to local hospitals, homes, and clinics. minimum of 35 Field visits a month. Mileage will be reimbursed.

(Southern MS - Hattiesburg to Coastal Areas)

Schedule: Monday thru Friday 8:00AM to 5:00PM. (No Weekends or Holidays)

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

• Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required.

• Works with participating ancillary providers, public agencies, or other service providers to make sure necessary services and equipment are in place for a safe transition.

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

• Coordinates care and reassesses member's needs using the Coleman Care Transitions Model recommended post-discharge timeline.

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

• RNs provide consultation, recommendations, and education as appropriate to non-RN case managers.

• RNs are assigned cases with members who have complex medical conditions and medication regimens.

• RNs will conduct medication reconciliation when needed.

• 40-50% local travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

1-3 years hospital discharge planning or home health.

Required License, Certification, Association

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

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

3-5 years hospital discharge planning or home health.

Preferred License, Certification, Association

Active, unrestricted Transitions of Care Sub-Specialty Certification and/or Certified Case Manager (CCM)

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

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

Pay Range: $26.41 - $51.49 an hour*

*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

For this position we are seeking a (RN) Registered Nurse who lives in MISSISSIPPI and must be licensed for the state of MISSISSIPPI. We are seeking RN's, who must live in either Northern or Southern Mississippi and must be licensed for the state of MS. Transition of Care RN will work with Medicaid population assisting with transition from hospital to next level of care. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members and providers on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important.

Home office with internet connectivity of high speed required.

Field Travel in the field to local hospitals, homes, and clinics. minimum of 35 Field visits a month. Mileage will be reimbursed.

(Southern MS - Hattiesburg to Coastal Areas)

Schedule: Monday thru Friday 8:00AM to 5:00PM. (No Weekends or Holidays)

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

• Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required.

• Works with participating ancillary providers, public agencies, or other service providers to make sure necessary services and equipment are in place for a safe transition.

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

• Coordinates care and reassesses member's needs using the Coleman Care Transitions Model recommended post-discharge timeline.

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

• RNs provide consultation, recommendations, and education as appropriate to non-RN case managers.

• RNs are assigned cases with members who have complex medical conditions and medication regimens.

• RNs will conduct medication reconciliation when needed.

• 40-50% local travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

1-3 years hospital discharge planning or home health.

Required License, Certification, Association

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

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

3-5 years hospital discharge planning or home health.

Preferred License, Certification, Association

Active, unrestricted Transitions of Care Sub-Specialty Certification and/or Certified Case Manager (CCM)

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

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

Pay Range: $26.41 - $51.49 an hour*

*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

For this position we are seeking a (RN) Registered Nurse who lives in MISSISSIPPI and must be licensed for the state of MISSISSIPPI. We are seeking RN's, who must live in either Northern or Southern Mississippi and must be licensed for the state of MS. Transition of Care RN will work with Medicaid population assisting with transition from hospital to next level of care. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members and providers on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important.

Home office with internet connectivity of high speed required.

Field Travel in the field to local hospitals, homes, and clinics. minimum of 35 Field visits a month. Mileage will be reimbursed.

(Southern MS - Hattiesburg to Coastal Areas)

Schedule: Monday thru Friday 8:00AM to 5:00PM. (No Weekends or Holidays)

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

• Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required.

• Works with participating ancillary providers, public agencies, or other service providers to make sure necessary services and equipment are in place for a safe transition.

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

• Coordinates care and reassesses member's needs using the Coleman Care Transitions Model recommended post-discharge timeline.

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

• RNs provide consultation, recommendations, and education as appropriate to non-RN case managers.

• RNs are assigned cases with members who have complex medical conditions and medication regimens.

• RNs will conduct medication reconciliation when needed.

• 40-50% local travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

1-3 years hospital discharge planning or home health.

Required License, Certification, Association

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

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

3-5 years hospital discharge planning or home health.

Preferred License, Certification, Association

Active, unrestricted Transitions of Care Sub-Specialty Certification and/or Certified Case Manager (CCM)

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

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

Pay Range: $26.41 - $51.49 an hour*

*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

For this position we are seeking a (RN) Registered Nurse who lives in MISSISSIPPI and must be licensed for the state of MISSISSIPPI. We are seeking RN's, who must live in either Northern or Southern Mississippi and must be licensed for the state of MS. Transition of Care RN will work with Medicaid population assisting with transition from hospital to next level of care. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members and providers on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important.

Home office with internet connectivity of high speed required.

Field Travel in the field to local hospitals, homes, and clinics. minimum of 35 Field visits a month. Mileage will be reimbursed.

(Southern MS - Hattiesburg to Coastal Areas)

Schedule: Monday thru Friday 8:00AM to 5:00PM. (No Weekends or Holidays)

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

• Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required.

• Works with participating ancillary providers, public agencies, or other service providers to make sure necessary services and equipment are in place for a safe transition.

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

• Coordinates care and reassesses member's needs using the Coleman Care Transitions Model recommended post-discharge timeline.

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

• RNs provide consultation, recommendations, and education as appropriate to non-RN case managers.

• RNs are assigned cases with members who have complex medical conditions and medication regimens.

• RNs will conduct medication reconciliation when needed.

• 40-50% local travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

1-3 years hospital discharge planning or home health.

Required License, Certification, Association

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

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

3-5 years hospital discharge planning or home health.

Preferred License, Certification, Association

Active, unrestricted Transitions of Care Sub-Specialty Certification and/or Certified Case Manager (CCM)

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

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

Pay Range: $26.41 - $51.49 an hour*

*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

For this position we are seeking a (RN) Registered Nurse who lives in MISSISSIPPI and must be licensed for the state of MISSISSIPPI. We are seeking RN's, who must live in either Northern or Southern Mississippi and must be licensed for the state of MS. Transition of Care RN will work with Medicaid population assisting with transition from hospital to next level of care. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members and providers on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important.

Home office with internet connectivity of high speed required.

Field Travel in the field to local hospitals, homes, and clinics. minimum of 35 Field visits a month. Mileage will be reimbursed.

(Southern MS - Hattiesburg to Coastal Areas)

Schedule: Monday thru Friday 8:00AM to 5:00PM. (No Weekends or Holidays)

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

• Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required.

• Works with participating ancillary providers, public agencies, or other service providers to make sure necessary services and equipment are in place for a safe transition.

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

• Coordinates care and reassesses member's needs using the Coleman Care Transitions Model recommended post-discharge timeline.

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

• RNs provide consultation, recommendations, and education as appropriate to non-RN case managers.

• RNs are assigned cases with members who have complex medical conditions and medication regimens.

• RNs will conduct medication reconciliation when needed.

• 40-50% local travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

1-3 years hospital discharge planning or home health.

Required License, Certification, Association

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

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

3-5 years hospital discharge planning or home health.

Preferred License, Certification, Association

Active, unrestricted Transitions of Care Sub-Specialty Certification and/or Certified Case Manager (CCM)

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

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

Pay Range: $26.41 - $51.49 an hour*

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

• Assists with all incoming calls and assist perspective members or members with health access related questions.

• Identify partnerships with key sponsorship opportunities and provide justification to determine Molina's participation.

• Identify and promote Molina's programs out in the community and creates opportunities for employees to participate.

• Responsible for managing their own daily schedule in alignment with department goals and initiatives as assigned by regions.

• Key in the development of SMART goals and provide input on department priorities.

JOB QUALIFICATIONS

Required Education:

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

Required Experience:

• Min. 3 years of related experience (e.g., marketing, business development, community engagement, healthcare industry).

• Demonstrated exceptional networking and negotiations skills.

• Demonstrated strong public speaking and presentations skills.

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

• Must be able to attend public events in outdoor venues in all weather conditions.

• Must be able to sit and stand for long periods.

• Must be able to drive up to 3 hours to attend events. Must be able to lift 30 pounds.

Required License, Certification, Association:

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

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

Preferred Education:

• Bachelor's Degree in Marketing or related discipline.

Preferred Experience:

• Solid understanding of Health Care Markets, primarily Medicaid.

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

• 5 years of outreach experience serving low-income populations.

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

• Experience presenting to influencer and low-income audiences.

• Experience in sales or marketing techniques.

• Fluency in a second language highly desirable.

Preferred License, Certification, Association:

• Active Life & Health Insurance

• Market Place Certified

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 Marketplace Facilitated Enroller (MFE) is responsible for identifying prospective members that do not have health insurance and assisting with the enrollment process ultimately making it easier for them to connect to the care they need. The MFE conducts interviews and screens potentially eligible recipients for enrollment into Government Programs such as Medicaid/Medicaid Managed Care, Child Health Plus and Essential Plan. Additionally, the MFE will assist in enrollment into Qualified Health Plans. The MFE must offer all plans and all products. MFEs assist families with their applications, provides assistance with completing the application, gathers the necessary documentation, and assists in selection of the appropriate health plan. The Enroller provides information on managed care programs and how to access care. The MFE is responsible for processing paperwork completely and accurately, including follow up visit documentation and other necessary reports. The MFE is also responsible for assisting current members with recertification with their plan. MFEs must source, develop and maintain professional, congenial relationships with local community agencies as well as county and state agency personnel who refer potentially eligible recipients.

KNOWLEDGE/SKILLS/ABILITIES

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

• Interview, screen and assist potentially eligible recipients with the enrollment process into Medicaid/Medicaid Managed Care, Child Health Plus the Essential Plan and Qualified Health Plans for Molina and other plans who operate in our service area

• Meet with consumers at various sites throughout the communities

• Provide education and support to individuals who are navigating a complex system by assisting consumers with the application process, explaining requirements and necessary documentation

• Identify and educate potential members on all aspects of the plan including answering questions regarding plan's features and benefits and walking client through the required disclosures

• Educate members on their options to make premium payments, including due dates

• Assist clients with choosing a plan and primary care physician

• Submit all completed applications, adhering to submission deadline dates as imposed by NYSOH and Molina enrollment guidelines and requirements

• Responsible for identifying and assisting current members who are due to re-certify their healthcare coverage by completing the annual recertification application including adding on additional eligible family members

• Respond to inquiries from prospective members and members within the marketing guidelines

• Must adhere to all NYSOH rules and regulations as applicable for MFE functions

• Outreach Projects

• Participate in events and community outreach projects to other agencies as assigned by Management for a minimum of 8 hours per week

• Establish and maintain good working relationships with external business partners such as hospital and provider

• organizations, city agencies and community-based organizations where enrollment activities are conducted

• Develop and strengthen relations to generate new opportunities

• Attend external meetings as required

• Attend community health fairs and events as required

• Occasional weekend or evening availability for special events.

JOB QUALIFICATIONS

Required Education

HS Diploma

Required Experience

• Minimum one year of experience working with State and Federal Health Insurance programs and populations

• Demonstrated organizational skills, time management skills and ability to work independently

• Ability to meet deadlines

• Excellent written and oral communication skills; strong presentation skills

• Basic computer skills including Microsoft Word and Excel

• Strong interpersonal skills

• A positive attitude with ability to adapt to change

• Must have reliable transportation and a valid NYS drivers' license with no restrictions

• Knowledge of Managed Care insurance plans

• Ability to work with a diverse population, including different ethnicities, cultural backgrounds, and/or underserved communities

• Ability to work a flexible schedule, including nights and weekends

Required License, Certification, Association

Successful completion of the NYSOH required training, certification and recertification

Preferred Education

AA/AS - Associates degree

Preferred Experience

Previous experience as a Marketplace Facilitated Enroller - Bilingual -

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.

#PJED

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

The Marketplace Facilitated Enroller (MFE) is responsible for identifying prospective members that do not have health insurance and assisting with the enrollment process ultimately making it easier for them to connect to the care they need. The MFE conducts interviews and screens potentially eligible recipients for enrollment into Government Programs such as Medicaid/Medicaid Managed Care, Child Health Plus and Essential Plan. Additionally, the MFE will assist in enrollment into Qualified Health Plans. The MFE must offer all plans and all products. MFEs assist families with their applications, provides assistance with completing the application, gathers the necessary documentation, and assists in selection of the appropriate health plan. The Enroller provides information on managed care programs and how to access care. The MFE is responsible for processing paperwork completely and accurately, including follow up visit documentation and other necessary reports. The MFE is also responsible for assisting current members with recertification with their plan. MFEs must source, develop and maintain professional, congenial relationships with local community agencies as well as county and state agency personnel who refer potentially eligible recipients.

KNOWLEDGE/SKILLS/ABILITIES

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

• Interview, screen and assist potentially eligible recipients with the enrollment process into Medicaid/Medicaid Managed Care, Child Health Plus the Essential Plan and Qualified Health Plans for Molina and other plans who operate in our service area

• Meet with consumers at various sites throughout the communities

• Provide education and support to individuals who are navigating a complex system by assisting consumers with the application process, explaining requirements and necessary documentation

• Identify and educate potential members on all aspects of the plan including answering questions regarding plan's features and benefits and walking client through the required disclosures

• Educate members on their options to make premium payments, including due dates

• Assist clients with choosing a plan and primary care physician

• Submit all completed applications, adhering to submission deadline dates as imposed by NYSOH and Molina enrollment guidelines and requirements

• Responsible for identifying and assisting current members who are due to re-certify their healthcare coverage by completing the annual recertification application including adding on additional eligible family members

• Respond to inquiries from prospective members and members within the marketing guidelines

• Must adhere to all NYSOH rules and regulations as applicable for MFE functions

• Outreach Projects

• Participate in events and community outreach projects to other agencies as assigned by Management for a minimum of 8 hours per week

• Establish and maintain good working relationships with external business partners such as hospital and provider

• organizations, city agencies and community-based organizations where enrollment activities are conducted

• Develop and strengthen relations to generate new opportunities

• Attend external meetings as required

• Attend community health fairs and events as required

• Occasional weekend or evening availability for special events.

JOB QUALIFICATIONS

Required Education

HS Diploma

Required Experience

• Minimum one year of experience working with State and Federal Health Insurance programs and populations

• Demonstrated organizational skills, time management skills and ability to work independently

• Ability to meet deadlines

• Excellent written and oral communication skills; strong presentation skills

• Basic computer skills including Microsoft Word and Excel

• Strong interpersonal skills

• A positive attitude with ability to adapt to change

• Must have reliable transportation and a valid NYS drivers' license with no restrictions

• Knowledge of Managed Care insurance plans

• Ability to work with a diverse population, including different ethnicities, cultural backgrounds, and/or underserved communities

• Ability to work a flexible schedule, including nights and weekends

Required License, Certification, Association

Successful completion of the NYSOH required training, certification and recertification

Preferred Education

AA/AS - Associates degree

Preferred Experience

Previous experience as a Marketplace Facilitated Enroller - Bilingual -

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.

#PJED

#LI-BEMORE

Job Detail

• Company:
  Molina Healthcare

Job Description

*Remote and must live in Virginia*

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

• Under general supervision, responsible for various provider services functions with an emphasis on working externally with the Plan's highest priority, high volume, strategic providers to educate, advocate and engage as valuable partners.

• Requires an in-depth knowledge of provider services and contracting subject matter expertise.

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

• Serves as a subject matter expert for other departments.

• Trains other Provider Services Representatives, as appropriate.

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

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

• 3-5 years' experience in managed healthcare administration and/or Provider Services.

• 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc.

• 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 or master's degree.

Preferred Experience

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

• 5+ years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, 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: $19.84 - $38.69 an hour*

*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 the Richmond, VA area***

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

• Under general supervision, responsible for various provider services functions with an emphasis on working externally with the Plan's highest priority, high volume, strategic providers to educate, advocate and engage as valuable partners.

• Requires an in-depth knowledge of provider services and contracting subject matter expertise.

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

• Serves as a subject matter expert for other departments.

• Trains other Provider Services Representatives, as appropriate.

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

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

• 3-5 years' experience in managed healthcare administration and/or Provider Services.

• 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc.

• 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 or master's degree.

Preferred Experience

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

• 5+ years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, 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: $45,390 - $88,511 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

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

JOB QUALIFICATIONS

Required Education

HS Diploma

Required Experience

1-3 years

Required License, Certification, Association

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

Preferred Education

Associate's Degree

Preferred Experience

3-5 years

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

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

Pay Range: $13.55 - $26.42 an hour*

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Responsible for analysis of financial reports, trend, and opportunities. Includes evaluation of and recommendations relating to business opportunities, investments, financial regulations, and similar financial projects or programs. Duties include gathering, interpreting, and evaluating financial information; generating forecasts and analyzes trends in sales, finance and other areas of business; Creating financial models for future business planning decisions in areas such as new product development, new marketing strategies, etc.

KNOWLEDGE/SKILLS/ABILITIES

• Responsible for timely submission of periodic financial reports.

• Leads the allocation of limited resources among different investments in infrastructure and operations by ranking based upon economic benefit.

• Leads the analysis of capital equipment purchases and lease vs. buy analysis.

• Acts as a role model and mentor to the members of the team.

• Participate in special projects, including automation and other efforts, to streamline and improve reporting processes.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree

Required Experience

5-6 Years

Required License, Certification, Association

CPA

Preferred Education

MBA

Preferred Experience

7+ Years

Pay Range: $66,456 - $129,590

*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

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

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

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Any of the following:

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

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

PREFERRED EXPERIENCE:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Any of the following:

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

Pay Range: $24.00 - 46.81 per hour*

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

*Remote and must live in Chambers, Jefferson, or Liberty County in Texas*

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

This role serves as the primary point of contact between Molina Health plan and the Provider community that serves Molina members. It's 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.

• 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. Such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding, for example.

• 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 Services 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

• 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.

Preferred Experience

• 5 years' experience in managed healthcare administration and/or Provider Services.

• 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, 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: $19.84 - $38.69 an hour*

*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

Opportunity for an experienced Case Manager to work with Molina Medicare members in Chicago, DeKalb, and Joliet, Illinois. Preferred candidates will either be a IL licensed LPN or a Bachelors/Master's trained Case Manager. Responsibilities will include meeting with members face-to-face in their homes. Hours are Monday - Friday, 8 AM - 5 PM; mileage is reimbursed as part of our benefit package.

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

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

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Any of the following:

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

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

PREFERRED EXPERIENCE:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Any of the following:

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

Pay Range: $24.00 - 46.81 per hour*

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Ideal candidate will reside in the Omaha, NE area.

Position is in Office (Omaha, NE) Monday - Friday 8:00am - 5:00pm

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

• Provides confidential administrative and office support under the direction of a department head.

• Receives and responds to routine correspondence following established procedures not requiring management review.

• Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner.

• May compile and analyzes basic information for inclusion in reports or presentation materials, prepares charts, graphs, or tables as necessary.

• May prepare moderately complex reports, maintaining records requiring classification and compilation of varied information.

• Coordinates meetings which may include preparing agendas and materials, and transcribing meetings along with distribution of documents.

• May manage calendars, visitors and appointments.

• May schedule and manage travel arrangements for department.

• May prepares expenses reports and manage submission process for supervisor

• May process business supply and/or facility requests.

• May process incoming, outgoing mail and shipments.

JOB QUALIFICATIONS

Required Education

High School diploma or equivalent GED

Required Experience

• 3 - 5 years office/clerical experience

• 2 - 3 years' experience with Microsoft Office Suite

Preferred Education

Business Related Courses

Preferred Experience

1 - 2 years' experience in an administrative role

Pay Range: $15.58 - $30.37 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

Ideal candidate will reside in the Omaha, NE area.

Position is in Office (Omaha, NE) Monday - Friday 8:00am - 5:00pm

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

• Provides confidential administrative and office support under the direction of a department head.

• Receives and responds to routine correspondence following established procedures not requiring management review.

• Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner.

• May compile and analyzes basic information for inclusion in reports or presentation materials, prepares charts, graphs, or tables as necessary.

• May prepare moderately complex reports, maintaining records requiring classification and compilation of varied information.

• Coordinates meetings which may include preparing agendas and materials, and transcribing meetings along with distribution of documents.

• May manage calendars, visitors and appointments.

• May schedule and manage travel arrangements for department.

• May prepares expenses reports and manage submission process for supervisor

• May process business supply and/or facility requests.

• May process incoming, outgoing mail and shipments.

JOB QUALIFICATIONS

Required Education

High School diploma or equivalent GED

Required Experience

• 3 - 5 years office/clerical experience

• 2 - 3 years' experience with Microsoft Office Suite

Preferred Education

Business Related Courses

Preferred Experience

1 - 2 years' experience in an administrative role

Pay Range: $15.58 - $30.37 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's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities.

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

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

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

This position may require same day out of office travel approximately 0 - 50% of the time, depending upon location.

This position may require multiple day out of town overnight travel approximately 0 - 20% of the time, depending upon location.

JOB QUALIFICATIONS

Required Education

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

Required Experience

• Min. 3 years' experience in healthcare with 1 year experience in health plan quality improvement, managed care, or equivalent experience.

• Demonstrated solid business writing experience.

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

Preferred Education

Preferred field: Clinical Quality, Public Health or Healthcare.

Preferred Experience

1 year of experience in Medicare and in Medicaid.

Preferred License, Certification, Association

• Certified Professional in Health Quality (CPHQ)

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

• Certified HEDIS Compliance Auditor (CHCA)

Pay Range: $21.82 - $42.55

*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

Opportunity for an experienced Case Manager to work with Molina Medicare members in Chicago, DeKalb, and Joliet, Illinois. Preferred candidates will either be a IL licensed LPN or a Bachelors/Master's trained Case Manager. Responsibilities will include meeting with members face-to-face in their homes. Hours are Monday - Friday, 8 AM - 5 PM; mileage is reimbursed as part of our benefit package.

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

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

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Any of the following:

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

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

PREFERRED EXPERIENCE:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Any of the following:

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

Pay Range: $24.00 - 46.81 per hour*

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

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

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

This position may require same day out of office travel approximately 0 - 50% of the time, depending upon location.

This position may require multiple day out of town overnight travel approximately 0 - 20% of the time, depending upon location.

JOB QUALIFICATIONS

Required Education

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

Required Experience

• Min. 3 years' experience in healthcare with 1 year experience in health plan quality improvement, managed care, or equivalent experience.

• Demonstrated solid business writing experience.

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

Preferred Education

Preferred field: Clinical Quality, Public Health or Healthcare.

Preferred Experience

1 year of experience in Medicare and in Medicaid.

Preferred License, Certification, Association

• Certified Professional in Health Quality (CPHQ)

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

• Certified HEDIS Compliance Auditor (CHCA)

Pay Range: $21.82 - $42.55

*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

Opportunity for an experienced Case Manager to work with Molina Medicare members in Chicago, DeKalb, and Joliet, Illinois. Preferred candidates will either be a IL licensed LPN or a Bachelors/Master's trained Case Manager. Responsibilities will include meeting with members face-to-face in their homes. Hours are Monday - Friday, 8 AM - 5 PM; mileage is reimbursed as part of our benefit package.

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

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

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Any of the following:

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

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

PREFERRED EXPERIENCE:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Any of the following:

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

Pay Range: $24.00 - 46.81 per hour*

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Opportunity for a IL licensed LPN or a experienced Case Manager who has either a Bachelors or Masters degree in an appropriate field to join our Medicare Team in Illinois. Coverage for this position is McLean, Tazewell, and Ford counties; meeting with members face-to-face in their homes is part of the responsibility of the role. Monday - Friday, 8AM - 430PM schedule and we reimburse mileage as part of our benefit package.

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

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

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Any of the following:

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

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

PREFERRED EXPERIENCE:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Any of the following:

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

Pay Range: $24.00 - 46.81 per hour*

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

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Opportunity for a IL licensed LPN or a experienced Case Manager who has either a Bachelors or Masters degree in an appropriate field to join our Medicare Team in central Illinois. Coverage for this position is Logan, Dewitt, and Macon Counties; meeting with members face-to-face in their homes is part of the responsibility of the role. Monday - Friday, 8AM - 430PM schedule and we reimburse mileage as part of our benefit package.

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

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

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Any of the following:

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

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

PREFERRED EXPERIENCE:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Any of the following:

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

Pay Range: $24.00 - 46.81 per hour*

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

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

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

Job Detail

• Company:
  Molina Healthcare