Company Detail

Job Description

CASE MANAGER REMOTE / FIELD

We are seeking a CASE MANAGER , Long Term Supports and Services for ILLINOIS. Candidates must live in WINNEBAGO / BOONE / OGLE COUNTY in the state of ILLINOIS for consideration.

We can consider a RN (Registered Nurse), or Social Worker (Bachelor's or Masters Degree in Psychology, Social work, or healthcare related)

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

Experience with WAIVERS preferred.

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

Schedule: Monday thru Friday 8/8:30AM to 5/5:30PM

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

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

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

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

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

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

• Required License, Certification, Association

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

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

State Specific Requirements

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

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

Preferred License, Certification, Association

Active and unrestricted 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: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

This position will be supporting our Washington State program. We are seeking a candidate with WA State LICSW, LMHC, LMFT, or Psychiatric Nurse RN licensure. Candidates should be proficient with Microsoft Office products, i.e. Excel, Word, OneNote. Further details to be discussed during our interview process .

Work schedule Monday - Friday 8:00am to 5:00pm PST.

Remote position preferrable in Washington State

KNOWLEDGE/SKILLS/ABILITIES

• Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.

• Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.

• Processes requests within required timelines.

• Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.

• Requests additional information from members or providers in consistent and efficient manner.

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

JOB QUALIFICATIONS

Required Education

Master's Degree in Social Work, Psychology, or other Behavioral Health field

Required Experience

3+ years Behavioral Health hospital acute care/medical experience.

Required License, Certification, Association

• Active, unrestricted State license in good standing, such as LCSW, LPCC or LMFT.

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

Preferred Education

Master's Degree in Clinical Social Work

Preferred Experience

Recent Behavioral Health hospital experience in ICU, Medical, or ER unit.

Proficient with Microsoft Office products, i.e. Excel, Word, OneNote.

Preferred License, Certification, Association

Active and unrestricted Licensed Clinical Social Worker

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: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

EMERGENCY ROOM ADMISSIONS REVIEW NURSE

PERMANENT SHIFT WILL BE :

12 hour NIGHT SHIFT: 7:30PM (in the evening) - 08:30AM (in the morning) PACIFIC HOURS NON EXEMPT, 3 days a week will rotate.

This department runs 24 / 7 / 365 days a year. Rotating weekends and holidays will be required. This position supports our California Health Plan. Candidates can live anywhere in the USA if they have a valid CALIFORNIA RN license must work the shift hours as posted. CALIFORNIA IS NOT a compact state at this time. Out of state candidates will need to work PACIFIC HOURS. Please consider this requirement before applying to this position.

TRAINING SCHEDULE WILL BE Monday thru Friday 8:30AM to 5:30PM PACIFIC throughout a 2 - 3 month training and then will move to a 3 day/12 hour shift from then on.

Previous experience with Emergency Room Utilization Management / Utilization Review is required for this role. Experience with Case Management is a plus.

This is a remote role (work from home). Excellent computer multi-tasking skills and analytical thought process is important to be successful in this role. Home office with high speed internet connectivity required. Productivity is important with turnaround times. Further details to be discussed during our interview process.

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

• Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.

• Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.

• Processes requests within required timelines.

• Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.

• Requests additional information from members or providers in consistent and efficient manner.

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

• Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

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

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

State Specific Requirements:

CALIFORNIA RN licensure is immediately required

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

Recent hospital experience in ICU, Medical, or ER unit.

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes

• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff

• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment

• Builds positive relationships between providers and Molina by providing coding assistance when necessary

• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education

• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Contributes to team effort by accomplishing related results as needed

• Other duties as assigned

• 2 years previous coding experience

• Proficient in Microsoft Office Suite

• Ability to effectively interface with staff, clinicians, and management

• Excellent verbal and written communication skills

• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers

• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model

• Background in supporting risk adjustment management activities and clinical informatics

• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder - (CRC)

• Certified Professional Payer - Payer (CPC-P)

• Certified Coding Specialist - Physician based (CCS-P)

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: $17.85 - $38.69 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

The Medical Assistant - Care Connections will communicate with members after appointments and services to ensure that they are receiving quality care. They will function as a liaison to share testing results, coordinate care between providers, and help the member navigate the health care system to receive appropriate follow up care. Communicates with the providers to clarify any orders or requests and assist with escalation of issues to the appropriate team when unable to resolve independently. In addition to working directly with members, they will perform various administrative tasks, documentation, and patient records updates.

KNOWLEDGE/SKILLS/ABILITIES

• Be a liaison for Molina members by following up with members after appointments or services to ensure they receive the highest quality care leading to better health outcomes

• Help at risk patients by processing and following-up on case management and primary care provider referrals

• Escalate patient issues related to prior authorizations for medications and durable medical equipment.

• Communicate lab results and other exam findings with members and Primary Care Providers as needed.

• Assist with follow up calls to members to ensure positive experience/outcomes and ensure patient needs are met.

• Communicate with Nurse Practitioner related to member health issues to ensure timely follow up and response.

• Facilitate care coordination and intervention by sending electronic messages/faxes to primary care physicians

• Close gaps in health care by preparing patient lab result letters and following-up on lab results

• Fulfill nurse practitioner supply orders and maintain adequate nursing supplies inventory

• Perform administrative tasks such as telephone and email inquiries, follow-up documentation and update patient records

• Assists with special projects under the direction of Clinical Integration leadership team.

JOB QUALIFICATIONS

Required Education

High School Diploma or GED

Required Experience

• At least 1-3 years of clinical experience preferably family practice, in-home health, primary care, palliative care, or hospice settings

• A basic understanding of patient care, medical terminology, coding procedures, reference tools, and appropriate clinical pharmacology for medical assistant practice scope

• Working knowledge of desktop software applications (e.g., Outlook, Word, Excel, Internet, Email)

• Ability to lift up to 50 lbs

• Excellent customer service and communication (written & verbal and can work independently or as part of a team

• Understanding and striving to meet or exceed Care Connections Clinical Integration and departmental metrics while providing excellent customer service

• Strong attention to detail, ability to multi-task, prioritize tasks, meet deadlines, and demonstrate attention to detail and follow through

• Can utilize critical thinking skills to identify issues, problem solve to logical conclusion and demonstration initiative

• Empathy for working with senior, disabled, income challenged /vulnerable populations

• Demonstrate positive working relationships with peers and effectively manage conflict

Required License, Certification, Association

Graduate of an accredited Certified Medical Assistant program

Preferred Experience

• Experience working as a Certified Medical Assistant for more than 1 year

• Experience working with an electronic medical record system, preferably Epic

• Experience with underserved populations facing socioeconomic barriers to healthcare

• Bilingual in Spanish, Korean, Mandarin, Cantonese, or Vietnamese

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: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

KNOWLEDGE/SKILLS/ABILITIES

Develop and deploy workforce management strategies nationwide. Partner with leaders by strategically identifying business needs and propose solutions in line with the needs of our members and providers. Requires contact center experience with in-depth Workforce Management experience specializing in planning efforts. Ensures the right numbers of skilled resources are in place at the right time to handle the workload. Identify gaps in coverage and propose solutions for the best possible outcome. Data integrity is critical to success, as is attention to detail. Must possess the ability to self-check consistently for the best possible outcome. Must have the ability to work well under pressure, with the ability to multitask.

Identify gaps in coverage and propose solutions for the best possible outcome. Data integrity is critical to success, as is attention to detail. Must possess the ability to self-check consistently for the best possible outcome. Must have the ability to work well under pressure, with the ability to multitask. This is a regional role with responsibility for supporting multiple plans based on business need.

• Develop templates and creating and using complex formulas.

• Provide analytical input related to trends within plans associate to call handle time and call volume, used to continuously improve forecasts and plans (workload)

• Maintains headcount/FTE requirements for each plan and works closely with leadership to ensure staffing is adequate to support compliance regulations

• Identifies gaps in coverage, and proposes new shifts or realignments along with hiring plans and predicts work volume

• Maintains attrition capacity modeling and management of PTO planning and all HR-related activities

• Measures performance in each discipline within transparent set of key metrics and targets and aligns appropriate schedules to meet business needs

• Maintains and updates employee information within Workforce Management database to support data integrity

• Maintains relationship with training team to ensure employees attend trainings at the best time for the business

• Provides production reporting to all levels of leadership based on business requirements

• Supports system integrity for Workforce Management software, Performance Manager and Cisco tools by communicating any known issues.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

Requires at least 3-5 years relevant experience with Workforce Management methodologies - expert level with call centers experience with call center operations, processes, and procedures, including and understanding of service objectives and contact center analytics

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

5+ years relevant experience with Workforce Management methodologies - expert level with call centers experience with call center operations, processes and procedures, including and understanding of service objectives and contact center analytics

Preferred License, Certification, Association

• Six Sigma Certification

• PMI Certification

• Business Analytics/Risk Management

• Workforce Certification

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

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

Pay Range: $16.23 - $35.17 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going compliance audits utilizing as necessary, state evaluation tools relating to audit/monitoring activities.

• Identifies and defines audit scope and criteria, reviews and analyzes evidence, and documents audit finds, including making recommendations for improvement and correction where identified.

• Provides comprehensive advice to assigned department regarding compliance risks with respect to Federal and State regulations and contract provisions.

• Provides significant input during the annual risk assessment and audit planning processes

• Assists with monitoring activities involving the effective execution of corrective action requirements imposed by state or federal regulatory agencies for contract deficiencies.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's degree in health care related area.

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

CASE MANAGER REMOTE / FIELD

We are seeking a CASE MANAGER , Long Term Supports and Services for ILLINOIS. Candidates must live in WINNEBAGO / BOONE / OGLE COUNTY in the state of ILLINOIS for consideration.

We can consider a RN (Registered Nurse), or Social Worker (Bachelor's or Masters Degree in Psychology, Social work, or healthcare related)

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

Experience with WAIVERS preferred.

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

Schedule: Monday thru Friday 8/8:30AM to 5/5:30PM

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

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

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

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

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

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

• Required License, Certification, Association

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

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

State Specific Requirements

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

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

Preferred License, Certification, Association

Active and unrestricted 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: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

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

REQUIRED EXPERIENCE:

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

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

PREFERRED EXPERIENCE:

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

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

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

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

STATE SPECIFIC REQUIREMENTS:

For the state of Wisconsin:

Bachelor's degree or more advanced degree in the human services area and a minimum of one (1) year experience working with at least one of the Family Care target populations; or

Bachelor's degree or more advanced degree in any area other than human services with a minimum of three (3) years' experience working with at least one of the Family Care target populations.

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

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

Pay Range: $21.6 - $46.81 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going compliance audits utilizing as necessary, state evaluation tools relating to audit/monitoring activities.

• Identifies and defines audit scope and criteria, reviews and analyzes evidence, and documents audit finds, including making recommendations for improvement and correction where identified.

• Provides comprehensive advice to assigned department regarding compliance risks with respect to Federal and State regulations and contract provisions.

• Provides significant input during the annual risk assessment and audit planning processes

• Assists with monitoring activities involving the effective execution of corrective action requirements imposed by state or federal regulatory agencies for contract deficiencies.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's degree in health care related area.

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

The Medical Assistant - Care Connections will communicate with members after appointments and services to ensure that they are receiving quality care. They will function as a liaison to share testing results, coordinate care between providers, and help the member navigate the health care system to receive appropriate follow up care. Communicates with the providers to clarify any orders or requests and assist with escalation of issues to the appropriate team when unable to resolve independently. In addition to working directly with members, they will perform various administrative tasks, documentation, and patient records updates.

KNOWLEDGE/SKILLS/ABILITIES

• Be a liaison for Molina members by following up with members after appointments or services to ensure they receive the highest quality care leading to better health outcomes

• Help at risk patients by processing and following-up on case management and primary care provider referrals

• Escalate patient issues related to prior authorizations for medications and durable medical equipment.

• Communicate lab results and other exam findings with members and Primary Care Providers as needed.

• Assist with follow up calls to members to ensure positive experience/outcomes and ensure patient needs are met.

• Communicate with Nurse Practitioner related to member health issues to ensure timely follow up and response.

• Facilitate care coordination and intervention by sending electronic messages/faxes to primary care physicians

• Close gaps in health care by preparing patient lab result letters and following-up on lab results

• Fulfill nurse practitioner supply orders and maintain adequate nursing supplies inventory

• Perform administrative tasks such as telephone and email inquiries, follow-up documentation and update patient records

• Assists with special projects under the direction of Clinical Integration leadership team.

JOB QUALIFICATIONS

Required Education

High School Diploma or GED

Required Experience

• At least 1-3 years of clinical experience preferably family practice, in-home health, primary care, palliative care, or hospice settings

• A basic understanding of patient care, medical terminology, coding procedures, reference tools, and appropriate clinical pharmacology for medical assistant practice scope

• Working knowledge of desktop software applications (e.g., Outlook, Word, Excel, Internet, Email)

• Ability to lift up to 50 lbs

• Excellent customer service and communication (written & verbal and can work independently or as part of a team

• Understanding and striving to meet or exceed Care Connections Clinical Integration and departmental metrics while providing excellent customer service

• Strong attention to detail, ability to multi-task, prioritize tasks, meet deadlines, and demonstrate attention to detail and follow through

• Can utilize critical thinking skills to identify issues, problem solve to logical conclusion and demonstration initiative

• Empathy for working with senior, disabled, income challenged /vulnerable populations

• Demonstrate positive working relationships with peers and effectively manage conflict

Required License, Certification, Association

Graduate of an accredited Certified Medical Assistant program

Preferred Experience

• Experience working as a Certified Medical Assistant for more than 1 year

• Experience working with an electronic medical record system, preferably Epic

• Experience with underserved populations facing socioeconomic barriers to healthcare

• Bilingual in Spanish, Korean, Mandarin, Cantonese, or Vietnamese

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: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

KNOWLEDGE/SKILLS/ABILITIES

Develop and deploy workforce management strategies nationwide. Partner with leaders by strategically identifying business needs and propose solutions in line with the needs of our members and providers. Requires contact center experience with in-depth Workforce Management experience specializing in planning efforts. Ensures the right numbers of skilled resources are in place at the right time to handle the workload. Identify gaps in coverage and propose solutions for the best possible outcome. Data integrity is critical to success, as is attention to detail. Must possess the ability to self-check consistently for the best possible outcome. Must have the ability to work well under pressure, with the ability to multitask.

Identify gaps in coverage and propose solutions for the best possible outcome. Data integrity is critical to success, as is attention to detail. Must possess the ability to self-check consistently for the best possible outcome. Must have the ability to work well under pressure, with the ability to multitask. This is a regional role with responsibility for supporting multiple plans based on business need.

• Develop templates and creating and using complex formulas.

• Provide analytical input related to trends within plans associate to call handle time and call volume, used to continuously improve forecasts and plans (workload)

• Maintains headcount/FTE requirements for each plan and works closely with leadership to ensure staffing is adequate to support compliance regulations

• Identifies gaps in coverage, and proposes new shifts or realignments along with hiring plans and predicts work volume

• Maintains attrition capacity modeling and management of PTO planning and all HR-related activities

• Measures performance in each discipline within transparent set of key metrics and targets and aligns appropriate schedules to meet business needs

• Maintains and updates employee information within Workforce Management database to support data integrity

• Maintains relationship with training team to ensure employees attend trainings at the best time for the business

• Provides production reporting to all levels of leadership based on business requirements

• Supports system integrity for Workforce Management software, Performance Manager and Cisco tools by communicating any known issues.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

Requires at least 3-5 years relevant experience with Workforce Management methodologies - expert level with call centers experience with call center operations, processes, and procedures, including and understanding of service objectives and contact center analytics

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

5+ years relevant experience with Workforce Management methodologies - expert level with call centers experience with call center operations, processes and procedures, including and understanding of service objectives and contact center analytics

Preferred License, Certification, Association

• Six Sigma Certification

• PMI Certification

• Business Analytics/Risk Management

• Workforce Certification

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

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

Pay Range: $16.23 - $35.17 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes

• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff

• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment

• Builds positive relationships between providers and Molina by providing coding assistance when necessary

• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education

• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Contributes to team effort by accomplishing related results as needed

• Other duties as assigned

• 2 years previous coding experience

• Proficient in Microsoft Office Suite

• Ability to effectively interface with staff, clinicians, and management

• Excellent verbal and written communication skills

• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers

• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model

• Background in supporting risk adjustment management activities and clinical informatics

• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder - (CRC)

• Certified Professional Payer - Payer (CPC-P)

• Certified Coding Specialist - Physician based (CCS-P)

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: $17.85 - $38.69 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

CASE MANAGER REMOTE / FIELD

We are seeking a CASE MANAGER , Long Term Supports and Services for ILLINOIS. Candidates must live in WINNEBAGO / BOONE / OGLE COUNTY in the state of ILLINOIS for consideration.

We can consider a RN (Registered Nurse), or Social Worker (Bachelor's or Masters Degree in Psychology, Social work, or healthcare related)

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

Experience with WAIVERS preferred.

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

Schedule: Monday thru Friday 8/8:30AM to 5/5:30PM

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

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

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

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

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

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

• Required License, Certification, Association

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

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

State Specific Requirements

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

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

Preferred License, Certification, Association

Active and unrestricted 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: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

EMERGENCY ROOM ADMISSIONS REVIEW NURSE

PERMANENT SHIFT WILL BE :

12 hour NIGHT SHIFT: 7:30PM (in the evening) - 08:30AM (in the morning) PACIFIC HOURS NON EXEMPT, 3 days a week will rotate.

This department runs 24 / 7 / 365 days a year. Rotating weekends and holidays will be required. This position supports our California Health Plan. Candidates can live anywhere in the USA if they have a valid CALIFORNIA RN license must work the shift hours as posted. CALIFORNIA IS NOT a compact state at this time. Out of state candidates will need to work PACIFIC HOURS. Please consider this requirement before applying to this position.

TRAINING SCHEDULE WILL BE Monday thru Friday 8:30AM to 5:30PM PACIFIC throughout a 2 - 3 month training and then will move to a 3 day/12 hour shift from then on.

Previous experience with Emergency Room Utilization Management / Utilization Review is required for this role. Experience with Case Management is a plus.

This is a remote role (work from home). Excellent computer multi-tasking skills and analytical thought process is important to be successful in this role. Home office with high speed internet connectivity required. Productivity is important with turnaround times. Further details to be discussed during our interview process.

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

• Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.

• Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.

• Processes requests within required timelines.

• Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.

• Requests additional information from members or providers in consistent and efficient manner.

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

• Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

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

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

State Specific Requirements:

CALIFORNIA RN licensure is immediately required

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

Recent hospital experience in ICU, Medical, or ER unit.

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

The Medical Assistant - Care Connections will communicate with members after appointments and services to ensure that they are receiving quality care. They will function as a liaison to share testing results, coordinate care between providers, and help the member navigate the health care system to receive appropriate follow up care. Communicates with the providers to clarify any orders or requests and assist with escalation of issues to the appropriate team when unable to resolve independently. In addition to working directly with members, they will perform various administrative tasks, documentation, and patient records updates.

KNOWLEDGE/SKILLS/ABILITIES

• Be a liaison for Molina members by following up with members after appointments or services to ensure they receive the highest quality care leading to better health outcomes

• Help at risk patients by processing and following-up on case management and primary care provider referrals

• Escalate patient issues related to prior authorizations for medications and durable medical equipment.

• Communicate lab results and other exam findings with members and Primary Care Providers as needed.

• Assist with follow up calls to members to ensure positive experience/outcomes and ensure patient needs are met.

• Communicate with Nurse Practitioner related to member health issues to ensure timely follow up and response.

• Facilitate care coordination and intervention by sending electronic messages/faxes to primary care physicians

• Close gaps in health care by preparing patient lab result letters and following-up on lab results

• Fulfill nurse practitioner supply orders and maintain adequate nursing supplies inventory

• Perform administrative tasks such as telephone and email inquiries, follow-up documentation and update patient records

• Assists with special projects under the direction of Clinical Integration leadership team.

JOB QUALIFICATIONS

Required Education

High School Diploma or GED

Required Experience

• At least 1-3 years of clinical experience preferably family practice, in-home health, primary care, palliative care, or hospice settings

• A basic understanding of patient care, medical terminology, coding procedures, reference tools, and appropriate clinical pharmacology for medical assistant practice scope

• Working knowledge of desktop software applications (e.g., Outlook, Word, Excel, Internet, Email)

• Ability to lift up to 50 lbs

• Excellent customer service and communication (written & verbal and can work independently or as part of a team

• Understanding and striving to meet or exceed Care Connections Clinical Integration and departmental metrics while providing excellent customer service

• Strong attention to detail, ability to multi-task, prioritize tasks, meet deadlines, and demonstrate attention to detail and follow through

• Can utilize critical thinking skills to identify issues, problem solve to logical conclusion and demonstration initiative

• Empathy for working with senior, disabled, income challenged /vulnerable populations

• Demonstrate positive working relationships with peers and effectively manage conflict

Required License, Certification, Association

Graduate of an accredited Certified Medical Assistant program

Preferred Experience

• Experience working as a Certified Medical Assistant for more than 1 year

• Experience working with an electronic medical record system, preferably Epic

• Experience with underserved populations facing socioeconomic barriers to healthcare

• Bilingual in Spanish, Korean, Mandarin, Cantonese, or Vietnamese

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: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes

• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff

• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment

• Builds positive relationships between providers and Molina by providing coding assistance when necessary

• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education

• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Contributes to team effort by accomplishing related results as needed

• Other duties as assigned

• 2 years previous coding experience

• Proficient in Microsoft Office Suite

• Ability to effectively interface with staff, clinicians, and management

• Excellent verbal and written communication skills

• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers

• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model

• Background in supporting risk adjustment management activities and clinical informatics

• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder - (CRC)

• Certified Professional Payer - Payer (CPC-P)

• Certified Coding Specialist - Physician based (CCS-P)

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: $17.85 - $38.69 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going compliance audits utilizing as necessary, state evaluation tools relating to audit/monitoring activities.

• Identifies and defines audit scope and criteria, reviews and analyzes evidence, and documents audit finds, including making recommendations for improvement and correction where identified.

• Provides comprehensive advice to assigned department regarding compliance risks with respect to Federal and State regulations and contract provisions.

• Provides significant input during the annual risk assessment and audit planning processes

• Assists with monitoring activities involving the effective execution of corrective action requirements imposed by state or federal regulatory agencies for contract deficiencies.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's degree in health care related area.

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

EMERGENCY ROOM ADMISSIONS REVIEW NURSE

PERMANENT SHIFT WILL BE :

12 hour NIGHT SHIFT: 7:30PM (in the evening) - 08:30AM (in the morning) PACIFIC HOURS NON EXEMPT, 3 days a week will rotate.

This department runs 24 / 7 / 365 days a year. Rotating weekends and holidays will be required. This position supports our California Health Plan. Candidates can live anywhere in the USA if they have a valid CALIFORNIA RN license must work the shift hours as posted. CALIFORNIA IS NOT a compact state at this time. Out of state candidates will need to work PACIFIC HOURS. Please consider this requirement before applying to this position.

TRAINING SCHEDULE WILL BE Monday thru Friday 8:30AM to 5:30PM PACIFIC throughout a 2 - 3 month training and then will move to a 3 day/12 hour shift from then on.

Previous experience with Emergency Room Utilization Management / Utilization Review is required for this role. Experience with Case Management is a plus.

This is a remote role (work from home). Excellent computer multi-tasking skills and analytical thought process is important to be successful in this role. Home office with high speed internet connectivity required. Productivity is important with turnaround times. Further details to be discussed during our interview process.

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

• Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.

• Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.

• Processes requests within required timelines.

• Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.

• Requests additional information from members or providers in consistent and efficient manner.

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

• Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

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

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

State Specific Requirements:

CALIFORNIA RN licensure is immediately required

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

Recent hospital experience in ICU, Medical, or ER unit.

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

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: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes

• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff

• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment

• Builds positive relationships between providers and Molina by providing coding assistance when necessary

• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education

• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Contributes to team effort by accomplishing related results as needed

• Other duties as assigned

• 2 years previous coding experience

• Proficient in Microsoft Office Suite

• Ability to effectively interface with staff, clinicians, and management

• Excellent verbal and written communication skills

• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers

• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model

• Background in supporting risk adjustment management activities and clinical informatics

• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder - (CRC)

• Certified Professional Payer - Payer (CPC-P)

• Certified Coding Specialist - Physician based (CCS-P)

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: $17.85 - $38.69 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

The Medical Assistant - Care Connections will communicate with members after appointments and services to ensure that they are receiving quality care. They will function as a liaison to share testing results, coordinate care between providers, and help the member navigate the health care system to receive appropriate follow up care. Communicates with the providers to clarify any orders or requests and assist with escalation of issues to the appropriate team when unable to resolve independently. In addition to working directly with members, they will perform various administrative tasks, documentation, and patient records updates.

KNOWLEDGE/SKILLS/ABILITIES

• Be a liaison for Molina members by following up with members after appointments or services to ensure they receive the highest quality care leading to better health outcomes

• Help at risk patients by processing and following-up on case management and primary care provider referrals

• Escalate patient issues related to prior authorizations for medications and durable medical equipment.

• Communicate lab results and other exam findings with members and Primary Care Providers as needed.

• Assist with follow up calls to members to ensure positive experience/outcomes and ensure patient needs are met.

• Communicate with Nurse Practitioner related to member health issues to ensure timely follow up and response.

• Facilitate care coordination and intervention by sending electronic messages/faxes to primary care physicians

• Close gaps in health care by preparing patient lab result letters and following-up on lab results

• Fulfill nurse practitioner supply orders and maintain adequate nursing supplies inventory

• Perform administrative tasks such as telephone and email inquiries, follow-up documentation and update patient records

• Assists with special projects under the direction of Clinical Integration leadership team.

JOB QUALIFICATIONS

Required Education

High School Diploma or GED

Required Experience

• At least 1-3 years of clinical experience preferably family practice, in-home health, primary care, palliative care, or hospice settings

• A basic understanding of patient care, medical terminology, coding procedures, reference tools, and appropriate clinical pharmacology for medical assistant practice scope

• Working knowledge of desktop software applications (e.g., Outlook, Word, Excel, Internet, Email)

• Ability to lift up to 50 lbs

• Excellent customer service and communication (written & verbal and can work independently or as part of a team

• Understanding and striving to meet or exceed Care Connections Clinical Integration and departmental metrics while providing excellent customer service

• Strong attention to detail, ability to multi-task, prioritize tasks, meet deadlines, and demonstrate attention to detail and follow through

• Can utilize critical thinking skills to identify issues, problem solve to logical conclusion and demonstration initiative

• Empathy for working with senior, disabled, income challenged /vulnerable populations

• Demonstrate positive working relationships with peers and effectively manage conflict

Required License, Certification, Association

Graduate of an accredited Certified Medical Assistant program

Preferred Experience

• Experience working as a Certified Medical Assistant for more than 1 year

• Experience working with an electronic medical record system, preferably Epic

• Experience with underserved populations facing socioeconomic barriers to healthcare

• Bilingual in Spanish, Korean, Mandarin, Cantonese, or Vietnamese

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: $13.41 - $29.06 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going compliance audits utilizing as necessary, state evaluation tools relating to audit/monitoring activities.

• Identifies and defines audit scope and criteria, reviews and analyzes evidence, and documents audit finds, including making recommendations for improvement and correction where identified.

• Provides comprehensive advice to assigned department regarding compliance risks with respect to Federal and State regulations and contract provisions.

• Provides significant input during the annual risk assessment and audit planning processes

• Assists with monitoring activities involving the effective execution of corrective action requirements imposed by state or federal regulatory agencies for contract deficiencies.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's degree in health care related area.

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going compliance audits utilizing as necessary, state evaluation tools relating to audit/monitoring activities.

• Identifies and defines audit scope and criteria, reviews and analyzes evidence, and documents audit finds, including making recommendations for improvement and correction where identified.

• Provides comprehensive advice to assigned department regarding compliance risks with respect to Federal and State regulations and contract provisions.

• Provides significant input during the annual risk assessment and audit planning processes

• Assists with monitoring activities involving the effective execution of corrective action requirements imposed by state or federal regulatory agencies for contract deficiencies.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's degree in health care related area.

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

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

Job Detail

• Company:
  Molina Healthcare

Job Description

KNOWLEDGE/SKILLS/ABILITIES

Develop and deploy workforce management strategies nationwide. Partner with leaders by strategically identifying business needs and propose solutions in line with the needs of our members and providers. Requires contact center experience with in-depth Workforce Management experience specializing in planning efforts. Ensures the right numbers of skilled resources are in place at the right time to handle the workload. Identify gaps in coverage and propose solutions for the best possible outcome. Data integrity is critical to success, as is attention to detail. Must possess the ability to self-check consistently for the best possible outcome. Must have the ability to work well under pressure, with the ability to multitask.

Identify gaps in coverage and propose solutions for the best possible outcome. Data integrity is critical to success, as is attention to detail. Must possess the ability to self-check consistently for the best possible outcome. Must have the ability to work well under pressure, with the ability to multitask. This is a regional role with responsibility for supporting multiple plans based on business need.

• Develop templates and creating and using complex formulas.

• Provide analytical input related to trends within plans associate to call handle time and call volume, used to continuously improve forecasts and plans (workload)

• Maintains headcount/FTE requirements for each plan and works closely with leadership to ensure staffing is adequate to support compliance regulations

• Identifies gaps in coverage, and proposes new shifts or realignments along with hiring plans and predicts work volume

• Maintains attrition capacity modeling and management of PTO planning and all HR-related activities

• Measures performance in each discipline within transparent set of key metrics and targets and aligns appropriate schedules to meet business needs

• Maintains and updates employee information within Workforce Management database to support data integrity

• Maintains relationship with training team to ensure employees attend trainings at the best time for the business

• Provides production reporting to all levels of leadership based on business requirements

• Supports system integrity for Workforce Management software, Performance Manager and Cisco tools by communicating any known issues.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

Requires at least 3-5 years relevant experience with Workforce Management methodologies - expert level with call centers experience with call center operations, processes, and procedures, including and understanding of service objectives and contact center analytics

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

5+ years relevant experience with Workforce Management methodologies - expert level with call centers experience with call center operations, processes and procedures, including and understanding of service objectives and contact center analytics

Preferred License, Certification, Association

• Six Sigma Certification

• PMI Certification

• Business Analytics/Risk Management

• Workforce Certification

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

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

Pay Range: $16.23 - $35.17 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes

• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff

• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment

• Builds positive relationships between providers and Molina by providing coding assistance when necessary

• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education

• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Contributes to team effort by accomplishing related results as needed

• Other duties as assigned

• 2 years previous coding experience

• Proficient in Microsoft Office Suite

• Ability to effectively interface with staff, clinicians, and management

• Excellent verbal and written communication skills

• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers

• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model

• Background in supporting risk adjustment management activities and clinical informatics

• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder - (CRC)

• Certified Professional Payer - Payer (CPC-P)

• Certified Coding Specialist - Physician based (CCS-P)

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: $17.85 - $38.69 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare