Company Detail

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

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

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

• Meet with consumers at various sites throughout the communities

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

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

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

• Assist clients with choosing a plan and primary care physician

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

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

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

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

• Outreach Projects

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

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

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

• Develop and strengthen relations to generate new opportunities

• Attend external meetings as required

• Attend community health fairs and events as required

• Occasional weekend or evening availability for special events.

JOB QUALIFICATIONS

Required Education

HS Diploma

Required Experience

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

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

• Ability to meet deadlines

• Excellent written and oral communication skills; strong presentation skills

• Basic computer skills including Microsoft Word and Excel

• Strong interpersonal skills

• A positive attitude with ability to adapt to change

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

• Knowledge of Managed Care insurance plans

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

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

Required License, Certification, Association

Successful completion of the NYSOH required training, certification and recertification

Preferred Education

AA/AS - Associates degree

Preferred Experience

Previous experience as a Marketplace Facilitated Enroller - Bilingual - Spanish & English

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

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

Pay Range: $14.76 - $31.97 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

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

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

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

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

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

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

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

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

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

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

• 50-80% local travel will be required and reliable transportation required.

• Will be covering counties listed below:

-Alpena (Alpena)

-Oscoda/Tawas (Iosco)

-Gaylord (Otsego)

-West Branch (Ogemaw)

JOB QUALIFICATIONS

REQUIRED EDUCATION:

HS Diploma/GED

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

- For Ohio, Florida, and California only -- Active and unrestricted Community Health Worker (CHW) Certification.

PREFERRED EDUCATION:

Associate's Degree in a health care related field (e.g., nutrition, counseling, social work).

PREFERRED EXPERIENCE:

- Bilingual based on community need.

- Familiarity with healthcare systems a plus.

- Knowledge of community-specific culture.

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

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

- Active and unrestricted Medical Assistant Certification

STATE SPECIFIC REQUIREMENTS: OHIO

- MHO Care Guide serves as a single point of contact for care coordination when there is no CCE, OhioRISE Plan, and/or CME involvement and short term care coordination needs are identified MHO Care Guide Plus serves as a single point of contact at Molina for care coordination when there is CCE, OhioRISE Plan, and/or CME involvement and short term care coordination needs are identified.

- Assures completion of a health risk assessment, assisting members to remediate immediate and acute gaps in care and access. Assist members with filing grievances and appeals.

- Connects members to CCEs, the OhioRISE Plan,or Molina Care Management if the members needs indicate a higher level of coordination. Provide information to members related to Molina requirements , services and benefits .

- Knowledge of internal MCO processes and procedures related to Care Guide responsibilities required

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

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

Pay Range: $14.76 - $31.97 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide.

Knowledge/Skills/Abilities

- Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines.

- Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.

- Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management.

- Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions.

- Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related.

- Coordinate, facilitate and document audit walkthroughs.

- Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal.

- Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed..

Job Qualifications

Required Education

Associate's Degree or two years of equivalent experience

Required Experience

- Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations:

- Analytical experience within managed care operations.

- Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions.

Preferred Education

Bachelor's Degree

Preferred Experience

- Six years proven analytical experience within an operations or process-focused environment.

- Previous audit and/or oversight experience.

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.

#PJCore

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

Responsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved market areas to achieve stated revenue, profitability, and retention goals, while following ethical sales practices and adhering to established policies and procedures.

KNOWLEDGE/SKILLS/ABILITIES

• Develop sales strategies to procure sufficient number of referrals and other self-generated leads to meet sales targets through active participation in community events and targeted community outreach to group associations, community centers, senior centers, senior residences and other potential marketing sites.

• Generate leads from referrals and local-tactical research and prospecting.

• Work assigned (company generated) leads in a timely manner.

• Schedule individual meetings and group presentations from assigned/self-generated leads.

• Achieve/Exceed monthly sales targets.

• Conduct presentations with potential customers. Customize sales presentations and develop sales skills to increase effectiveness in establishing rapport, assessing individual needs, and communicating product features and differences.

• Enroll eligible individuals in Molina Medicare products accurately and thoroughly complete and submit required enrollment documentation, consistent with Medicare requirements and enrollment guidelines. Assist the prospect in completion of the enrollment application. Forward completed applications to appropriate administrative contact within 48 hours of sale.

• Ensure Medicare beneficiaries accurately understand the product choices available to them, the enrollment process (eligibility requirements, Medicare review/approval of their enrollment application, timing of ID card receipt, etc.) and the service contacts and process.

• Track all marketing and sales activities, as well as update and maintain sales prospects daily, weekly and monthly results in SalesForce.com.

• Work closely with network providers to identify and educate potential members; participate in provider promotional activities.

JOB QUALIFICATIONS

Required Education

High School diploma/GED

Required Experience

2+ years Medicare, Medicaid, managed care or other health/insurance related sales experience

Required License, Certification, Association

Active, unrestricted Life & Health (Disability) Agent license

Preferred Education

AA degree

Preferred Experience

Bi-lingual

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

#PJSales

#LI-AC1

Pay Range: $33,761.52 - $73,149.97 / ANNUAL

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

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide.

Knowledge/Skills/Abilities

- Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines.

- Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.

- Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management.

- Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions.

- Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related.

- Coordinate, facilitate and document audit walkthroughs.

- Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal.

- Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed..

Job Qualifications

Required Education

Associate's Degree or two years of equivalent experience

Required Experience

- Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations:

- Analytical experience within managed care operations.

- Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions.

Preferred Education

Bachelor's Degree

Preferred Experience

- Six years proven analytical experience within an operations or process-focused environment.

- Previous audit and/or oversight experience.

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.

#PJCore

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 Manager, Business Development, Facilitated Enrollments, is responsible for for overseeing daily operations and driving individual and team performance. The Manager will lead a team of Facilitated Enrollers in a designated region(s) making data-informed decisions to drive performance, resource allocation and lead generation.

This is a field-based leadership role that is accountable for meeting sales and enrollment targets, as well as increasing market share, leveraging product and market synergies driving overall membership growth and retention. Leads managed-care related business development activities for competitive intelligence, which may also include attendance/participation national, state, and local conferences, seminars, and meetings as well as any other business development support activities, as needed.

Job Duties

• Manage and oversee a local field-based team of Facilitated Enrollers that orchestrate member events, potential customer events, and community-based goodwill and general awareness that make Molina the insurer of choice

• Leads business development support projects from inception through completion.

• Develop and execute effective business plans to reflect strategy, tactics, key relationships, and commensurate resources for the respective region. This will include goals, recruitment, sales/business development events, market partnerships, and engagement

• Conduct regular sales-related training/coaching, focusing on increasing sales, overcoming objections, expanding markets, selling the full portfolio, presentations skills, prospecting, compliance and quality updates, etc.

• Build, maintain, deepen, and leverage internal and external strategic relationships that create sales opportunities.

• Leads analyses and market research utilized for business development activities.

• Gathers research and intelligence, including monitoring activity in other markets.

• Create and execute effective resource sharing strategies, including lead routing, kiosk assignments, community meeting assignments, and participation in other Molina best practices.

• Collaborate with the Marketing team to produce positive outcomes, notably lead generation, member enrollment, and membership growth

• Focus on professional development of the team and mentoring the Facilitated Enrollers

• Develop and implement provider engagement strategies

• Ensure compliance with state regulations as well as health plan policies and procedures

Job Qualifications

REQUIRED EDUCATION :

Bachelor's Degree or equivalent work experience

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

• Minimum 5-7 years sales or sales experience (Demonstrated experience managing a team of sales and/or outreach staff with KPIs in a regulated environment)

• Minimum 5-7 years of business to business, business to consumer direct marketing, outside sales, or community outreach experience

• Demonstrated Proficiency in Microsoft Office; Agility in the use of data management databases (i.e. SharePoint, PowerBi).

• Strong communication skills, including written, phone and video to manage and engage with corporate and external partners (ie Providers, community based organizations, etc...) in a culturally competent manner

• Strong relationship building skills and ability to work engage customers and prospective members

• Ability to manage and prioritize deliverables

• Effective in sourcing and use of market research information and market strategies

• Prior experience in structured sales, service, or business development

• Experience in a deadline-driven environment to meet or exceed sales promotion/marketing targets in compliant manner within a heavily regulated marketplace.

• Understanding of Individual Exchange, Medicaid, and NY State of Health Marketplace

• Able to travel State wide up to 80% of the time within assigned sales territories

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION :

• Must have reliable transportation and a valid state driver's license with no restrictions meeting Molina requirements

PREFERRED EDUCATION :

• Graduate Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE :

• Understanding of the healthcare industry

• Bilingual skills

• Local market experience

• Experience working with communities of all different ethnicities, cultural backgrounds, diverse populations, and/or underserved communities

• Creative thinker with proven track record of innovative ideas working within structured (including matrixed organizations), high velocity environments

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

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

Pay Range: $72,370.82 - $156,803.45 / ANNUAL

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Responsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved market areas to achieve stated revenue, profitability, and retention goals, while following ethical sales practices and adhering to established policies and procedures.

KNOWLEDGE/SKILLS/ABILITIES

• Develop sales strategies to procure sufficient number of referrals and other self-generated leads to meet sales targets through active participation in community events and targeted community outreach to group associations, community centers, senior centers, senior residences and other potential marketing sites.

• Generate leads from referrals and local-tactical research and prospecting.

• Work assigned (company generated) leads in a timely manner.

• Schedule individual meetings and group presentations from assigned/self-generated leads.

• Achieve/Exceed monthly sales targets.

• Conduct presentations with potential customers. Customize sales presentations and develop sales skills to increase effectiveness in establishing rapport, assessing individual needs, and communicating product features and differences.

• Enroll eligible individuals in Molina Medicare products accurately and thoroughly complete and submit required enrollment documentation, consistent with Medicare requirements and enrollment guidelines. Assist the prospect in completion of the enrollment application. Forward completed applications to appropriate administrative contact within 48 hours of sale.

• Ensure Medicare beneficiaries accurately understand the product choices available to them, the enrollment process (eligibility requirements, Medicare review/approval of their enrollment application, timing of ID card receipt, etc.) and the service contacts and process.

• Track all marketing and sales activities, as well as update and maintain sales prospects daily, weekly and monthly results in SalesForce.com.

• Work closely with network providers to identify and educate potential members; participate in provider promotional activities.

JOB QUALIFICATIONS

Required Education

High School diploma/GED

Required Experience

2+ years Medicare, Medicaid, managed care or other health/insurance related sales experience

Required License, Certification, Association

Active, unrestricted Life & Health (Disability) Agent license

Preferred Education

AA degree

Preferred Experience

Bi-lingual

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

#PJSales

#LI-AC1

Pay Range: $33,761.52 - $73,149.97 / 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

For this position we are seeking a LPN who lives in VIRGINIA and must be licensed for the state of VIRGINIA. We are looking for candidates who live in within the state VA.

Case Manager will work in remote and field setting supporting 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.

(Up to 25%) TRAVEL in the field to do member visits in the surrounding areas will be required within 2-hour travel radius - Mileage will be reimbursed. - Travel will be within a 2-hour radius.

Locations (Various within VA): Southwest VA (Wise, Big Stone Gap, Norton, East Stone Gap)

Monday - Friday 8 AM to 5 PM EST - No Holidays or Weekends

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

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

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Any of the following:

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

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

STATE SPECIFIC REQUIREMENTS:

Roles serving Family Care and Family Care Partnership in the State of Wisconsin are required to have a Bachelor's Degree and a minimum of one year of professional experience.

PREFERRED EXPERIENCE:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Any of the following:

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

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

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

Pay Range: $21.6 - $46.81 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

For this position we are seeking a LPN who lives in VIRGINIA and must be licensed for the state of VIRGINIA. We are looking for candidates who live in within the state VA.

Case Manager will work in remote and field setting supporting 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.

(Up to 25%) TRAVEL in the field to do member visits in the surrounding areas will be required within 2-hour travel radius - Mileage will be reimbursed. - Travel will be within a 2-hour radius.

Locations (Various within VA): Southwest VA (Wise, Big Stone Gap, Norton, East Stone Gap)

Monday - Friday 8 AM to 5 PM EST - No Holidays or Weekends

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

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

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

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

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

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

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

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

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

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

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

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

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

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Any of the following:

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

REQUIRED EXPERIENCE:

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

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

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

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

STATE SPECIFIC REQUIREMENTS:

Roles serving Family Care and Family Care Partnership in the State of Wisconsin are required to have a Bachelor's Degree and a minimum of one year of professional experience.

PREFERRED EXPERIENCE:

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Any of the following:

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

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

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

Pay Range: $21.6 - $46.81 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare