Company Detail

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

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 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 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

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

Supporting the OH Plan, the candidate will act as a liaison to our state regulator on Encounters as well as lead various other technical programs under the OH Operations Department. These currently include support of provider data requirements, vendor data interfaces, Ohio Dept of Medicaid data interfaces, and be a technical resource that can liaison between OH Operations Dept and IT teams. Must be a self-starter willing to learn. Must be a good communicator, comfortable speaking up in group discussions and love work collaboratively with other teams and with senior leadership. This role involves research, root cause analysis, sharing recommendations, analyzing reports and other duties as specified.

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

KNOWLEDGE/SKILLS/ABILITIES

• Develops, implements and uses software and systems to identify issues in data sourced from state and federal agencies and loaded to internal systems.

• Identify data trends.

• Good knowledge of EDI X12 Transactions such as 834, 835, 837, etc.

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

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

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

• Encourages cooperative interactions between cross functional teammates.

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

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

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

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

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

• 7+ years of business analysis experience,

• 6+ years managed care experience.

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

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

• 6+ years experience working as a data or business analyst

• Experienced in developing ad-hoc and standard reports using SQL and Azure Databricks or similar tools to perform analysis on member enrollment data

• Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.

Preferred License, Certification, Association

QNXT or similar healthcare payer applications

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: $59,810.6 - $129,589.63 / 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

Case Manager position available in San Antonio, TX. Applicants should reside in the community, hold an active RN license in good standing in Texas, and have experience working as a case manager in nursing facilities. Part of your responsibilities is working with the nursing facility staff and seeing the members in the nursing facilities. Preference will be given to those with this type of experience having worked for a MCO organization like Molina. Hours are Monday - Friday, 8 AM - 5 PM CST and mileage is reimbursed as part of our benefit package.

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

• Completes 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

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 Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, community, and nursing facility settings. Provides needed care in the environment that patients feel most comfortable and are most receptive including home, nursing facilities, and -pop up- clinic.

The Nurse Practitioner will be required to work primarily in non-clinical settings and provide medical care to all levels of patients. Some programs may focus on specific populations (e.g., adult and geriatric, pediatric, women's health).

Perform comprehensive medical assessments, order appropriate tests/procedures for diagnostic purposes, formulate treatment plans, obtain specialists' consultations as needed, and do appropriate documentations as required.

* New Grads are welcome*

You will love this job if:

• You consider yourself a self-starter and enjoy being outside of the four walls of a clinic or hospital.

• You consider yourself an innovator and would like to participate in pilots for new services or care models.

• You are tech savvy and want to learn more about Clinical Informatics or Health Information Technology.

• New grads/exp NP who want to make a difference in the community.

Who is the ideal candidate?

• A passion to serve the underserved

• Previous experience working with Medicaid, Marketplace, and Medicare populations.

• Epic EHR experience

• Bilingual or multi-lingual communication skills

Job Duties

• Provide general medical care and care coordination to various and/or specific patient levels - adults, women's health, pediatric, and geriatric.

• Perform comprehensive evaluations including history and physical exams for gaps in care and preventative assessments

• Address both chronic and acute primary care complaints, and able to ascertain medical urgency

• Establish and document reasonable medical diagnoses

• Seek specialty consultation as appropriate

• Order/perform pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptom; able to work within an environment of limited resources and therefore uses diagnostic tests judiciously and appropriately

• Responsible for knowing when a patient's needs are beyond their scope of knowledge and when physician oversight is needed.

• Create and implements a medical plan of care

• Schedule patient appointments for visits when appropriate

• Provide post discharge coordination to reduce hospital readmission rates and emergency room utilization

• Perform face-to-face in-person visits in a variety of settings including home, skilled nursing facilities, and public locations.

• Additionally, may perform face-to-face visits via alternate modalities based on business need, leadership direction, and state regulations

• Order bulk laboratory orders to target specific populations of member.

• Perform alternating on-call coverage to triage any urgent lab results and pharmacy inquiries and develop appropriate plan of care

• Participate in community-based -Pop Up Clinics- as way of building relationship with community while addressing gaps in health care

• Drive up to 120 miles a day on a regular basis to a variety of locations within the assigned region. There may be drives beyond 120 miles as part of Extended Mileage Special Project days. Special Projects may include an overnight hotel stay.

• Obtain and maintain cross state license in other states besides home state based on business need.

• Collaborate with fellow nurse practitioners to develop best practices to perform work duties efficiently and effectively

• Actively participate in regional meetings

• Prescribe medications and perform procedures as appropriate

• Perform timely documentation in medical records in an electronic medical record computer system

• On occasion, may be required to walk flights of stairs while carrying up to 50 lbs. of equipment

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Master's degree in family health from accredited nursing program

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

Advanced computer skills. Proficient with Word, Excel, and Electronic Medical Record.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

• An active and unrestricted national certification from one of the following organizations: American Academy of Nurse Practitioners; American Nurses Credentialing Center

• Current state-issued license to practice as a Family Nurse Practitioner

• Current Basic Life Support for Healthcare Professional certification

• Current unrestricted driver's license

PREFERRED EDUCATION:

PREFERRED EXPERIENCE:

• 3-5-year experience as a Registered Nurse and/or Nurse Practitioner, ideally in a home health, community health, or public health setting

• Previous experience in home health as a licensed clinician, especially in management of chronic conditions

• Experience with underserved populations facing socioeconomic barriers to health care

• Fluency in a language in addition to English is plus

• Immunization and point of care testing skills

Additional Perks

• Flexible scheduling with either 4x10-hour or 5x8-hour shift

• $30k nursing loan repayment over 3 years

• $2,500 + 40 hours for CME annually

• Home office stipend, mileage reimbursement, cell phone

• Tuition/Certification Reimbursement- $5,250 annually

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

The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, community, and nursing facility settings. Provides needed care in the environment that patients feel most comfortable and are most receptive including home, nursing facilities, and -pop up- clinic.

The Nurse Practitioner will be required to work primarily in non-clinical settings and provide medical care to all levels of patients. Some programs may focus on specific populations (e.g., adult and geriatric, pediatric, women's health).

Perform comprehensive medical assessments, order appropriate tests/procedures for diagnostic purposes, formulate treatment plans, obtain specialists' consultations as needed, and do appropriate documentations as required.

* New Grads are welcome*

You will love this job if:

• You consider yourself a self-starter and enjoy being outside of the four walls of a clinic or hospital.

• You consider yourself an innovator and would like to participate in pilots for new services or care models.

• You are tech savvy and want to learn more about Clinical Informatics or Health Information Technology.

• New grads/exp NP who want to make a difference in the community.

Who is the ideal candidate?

• A passion to serve the underserved

• Previous experience working with Medicaid, Marketplace, and Medicare populations.

• Epic EHR experience

• Bilingual or multi-lingual communication skills

Job Duties

• Provide general medical care and care coordination to various and/or specific patient levels - adults, women's health, pediatric, and geriatric.

• Perform comprehensive evaluations including history and physical exams for gaps in care and preventative assessments

• Address both chronic and acute primary care complaints, and able to ascertain medical urgency

• Establish and document reasonable medical diagnoses

• Seek specialty consultation as appropriate

• Order/perform pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptom; able to work within an environment of limited resources and therefore uses diagnostic tests judiciously and appropriately

• Responsible for knowing when a patient's needs are beyond their scope of knowledge and when physician oversight is needed.

• Create and implements a medical plan of care

• Schedule patient appointments for visits when appropriate

• Provide post discharge coordination to reduce hospital readmission rates and emergency room utilization

• Perform face-to-face in-person visits in a variety of settings including home, skilled nursing facilities, and public locations.

• Additionally, may perform face-to-face visits via alternate modalities based on business need, leadership direction, and state regulations

• Order bulk laboratory orders to target specific populations of member.

• Perform alternating on-call coverage to triage any urgent lab results and pharmacy inquiries and develop appropriate plan of care

• Participate in community-based -Pop Up Clinics- as way of building relationship with community while addressing gaps in health care

• Drive up to 120 miles a day on a regular basis to a variety of locations within the assigned region. There may be drives beyond 120 miles as part of Extended Mileage Special Project days. Special Projects may include an overnight hotel stay.

• Obtain and maintain cross state license in other states besides home state based on business need.

• Collaborate with fellow nurse practitioners to develop best practices to perform work duties efficiently and effectively

• Actively participate in regional meetings

• Prescribe medications and perform procedures as appropriate

• Perform timely documentation in medical records in an electronic medical record computer system

• On occasion, may be required to walk flights of stairs while carrying up to 50 lbs. of equipment

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Master's degree in family health from accredited nursing program

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

Advanced computer skills. Proficient with Word, Excel, and Electronic Medical Record.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

• An active and unrestricted national certification from one of the following organizations: American Academy of Nurse Practitioners; American Nurses Credentialing Center

• Current state-issued license to practice as a Family Nurse Practitioner

• Current Basic Life Support for Healthcare Professional certification

• Current unrestricted driver's license

PREFERRED EDUCATION:

PREFERRED EXPERIENCE:

• 3-5-year experience as a Registered Nurse and/or Nurse Practitioner, ideally in a home health, community health, or public health setting

• Previous experience in home health as a licensed clinician, especially in management of chronic conditions

• Experience with underserved populations facing socioeconomic barriers to health care

• Fluency in a language in addition to English is plus

• Immunization and point of care testing skills

Additional Perks

• Flexible scheduling with either 4x10-hour or 5x8-hour shift

• $30k nursing loan repayment over 3 years

• $2,500 + 40 hours for CME annually

• Home office stipend, mileage reimbursement, cell phone

• Tuition/Certification Reimbursement- $5,250 annually

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

Supporting the OH Plan, the candidate will act as a liaison to our state regulator on Encounters as well as lead various other technical programs under the OH Operations Department. These currently include support of provider data requirements, vendor data interfaces, Ohio Dept of Medicaid data interfaces, and be a technical resource that can liaison between OH Operations Dept and IT teams. Must be a self-starter willing to learn. Must be a good communicator, comfortable speaking up in group discussions and love work collaboratively with other teams and with senior leadership. This role involves research, root cause analysis, sharing recommendations, analyzing reports and other duties as specified.

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

KNOWLEDGE/SKILLS/ABILITIES

• Develops, implements and uses software and systems to identify issues in data sourced from state and federal agencies and loaded to internal systems.

• Identify data trends.

• Good knowledge of EDI X12 Transactions such as 834, 835, 837, etc.

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

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

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

• Encourages cooperative interactions between cross functional teammates.

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

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

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

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

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

• 7+ years of business analysis experience,

• 6+ years managed care experience.

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

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

• 6+ years experience working as a data or business analyst

• Experienced in developing ad-hoc and standard reports using SQL and Azure Databricks or similar tools to perform analysis on member enrollment data

• Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.

Preferred License, Certification, Association

QNXT or similar healthcare payer applications

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: $59,810.6 - $129,589.63 / 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

Supporting the OH Plan, the candidate will act as a liaison to our state regulator on Encounters as well as lead various other technical programs under the OH Operations Department. These currently include support of provider data requirements, vendor data interfaces, Ohio Dept of Medicaid data interfaces, and be a technical resource that can liaison between OH Operations Dept and IT teams. Must be a self-starter willing to learn. Must be a good communicator, comfortable speaking up in group discussions and love work collaboratively with other teams and with senior leadership. This role involves research, root cause analysis, sharing recommendations, analyzing reports and other duties as specified.

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

KNOWLEDGE/SKILLS/ABILITIES

• Develops, implements and uses software and systems to identify issues in data sourced from state and federal agencies and loaded to internal systems.

• Identify data trends.

• Good knowledge of EDI X12 Transactions such as 834, 835, 837, etc.

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

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

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

• Encourages cooperative interactions between cross functional teammates.

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

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

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

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

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

• 7+ years of business analysis experience,

• 6+ years managed care experience.

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

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

• 6+ years experience working as a data or business analyst

• Experienced in developing ad-hoc and standard reports using SQL and Azure Databricks or similar tools to perform analysis on member enrollment data

• Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.

Preferred License, Certification, Association

QNXT or similar healthcare payer applications

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: $59,810.6 - $129,589.63 / 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

Supporting the OH Plan, the candidate will act as a liaison to our state regulator on Encounters as well as lead various other technical programs under the OH Operations Department. These currently include support of provider data requirements, vendor data interfaces, Ohio Dept of Medicaid data interfaces, and be a technical resource that can liaison between OH Operations Dept and IT teams. Must be a self-starter willing to learn. Must be a good communicator, comfortable speaking up in group discussions and love work collaboratively with other teams and with senior leadership. This role involves research, root cause analysis, sharing recommendations, analyzing reports and other duties as specified.

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

KNOWLEDGE/SKILLS/ABILITIES

• Develops, implements and uses software and systems to identify issues in data sourced from state and federal agencies and loaded to internal systems.

• Identify data trends.

• Good knowledge of EDI X12 Transactions such as 834, 835, 837, etc.

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

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

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

• Encourages cooperative interactions between cross functional teammates.

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

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

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

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

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

• 7+ years of business analysis experience,

• 6+ years managed care experience.

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

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

• 6+ years experience working as a data or business analyst

• Experienced in developing ad-hoc and standard reports using SQL and Azure Databricks or similar tools to perform analysis on member enrollment data

• Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.

Preferred License, Certification, Association

QNXT or similar healthcare payer applications

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: $59,810.6 - $129,589.63 / 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

We are seeking RN (Registered Nurse), who must live in the CINCINNATI OHIO area, and must be licensed for the state of OHIO. 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 working with our Medicare Waiver Population. This role will require telephonic and face to face assessments with members.

TRAVEL in the field to do member visits in the surrounding areas will be required. Mileage will be reimbursed.

Home office with internet connectivity of high speed required.

Schedule: Monday thru Friday 8:00AM to 5:00PM

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 comprehensive 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 identified in 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 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/home and community to enhance the continuity of care for Molina members.

• 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.

• 25- 40% local travel required.

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

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

• RNs conduct medication reconciliation when needed.

JOB QUALIFICATIONS

Required Education

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

Required Experience

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 (RN) license in good standing.

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

Preferred License, Certification, Association

Active, 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

Molina Healthcare is hiring a Manager of Growth and Community Engagement in the Des Moines area.

For over 40 years, Molina Healthcare has been a purpose-driven company committed to improving the lives and well-being of our members, while making a positive impact in the communities we serve. Our mission, vision and values help lead every decision we make - from the office of the CEO to our valued call center representatives.

The Manager of Growth & Community Engagement will be responsible for achieving established goals improving Molina's enrollment growth objectives encompassing all lines of business. You will work collaboratively with key departments across the enterprise to improve overall choice rates and assignment percentages.

Highly qualified applicants will have the following :

• Live in/near the greater Des Moines area and open to travel with the state of Iowa.

• Understand this role is approximately 50% +/- travel.

• Weekend and evening availability (Availability for events. You will flex other days off)

• Previous experience in a community facing role. Knows and understands the communities in Iowa.

• Previous leadership/ management experience.

• Proficient in Excel for reporting purposes.

• Recent experience in business development, community relations and/or health care related activities. Growth mindset.

KNOWLEDGE/SKILLS/ABILITIES

• Works closely with the AVP/Director to develop and execute the enrollment growth strategy for a specific area, while also being accountable to achieve assigned membership growth targets.

• Accountable for achieving established goals with the primary responsibility for improving the plan's overall -choice- rate. In addition, works collaboratively with other key departments to increase Medicaid assignment percentages for Molina.

• Responsible for day-to-day operations and management of team members, including hiring, training, developing, coaching and mentoring, etc. Creates and regularly reviews team performance metrics/scorecards to ensure team performance contributes to overall enrollment growth, while providing clear direction and intermittent steps to achieve success.

• Contributes to the development, implementation, and evaluation of the enrollment growth plan for assigned territory; plans enrollment activities to promote membership growth.

• Collaborates with other Lines of Business' sales teams to identify growth opportunities focused on key providers and Community Based Organizations.

• Leads team in the development of relationships with key providers, Community Based Organizations (CBOs), Faith Based Organizations (FBOs), School Based Organizations (SBOs) and Business Based Organizations (BBOs) and how to move them through the enrollment pipeline.

• Directs the coordination, development and approval of State/Federal guidelines for all marketing and promotional materials for all product lines.

• Demonstrates thorough understanding of Molina's product lines, Medicaid, CHIP, Medicare SNP, Marketplace, MMP, etc

• #LI-TR1

REQUIRED EDUCATION: Bachelor's Degree or equivalent experience.

P REFERRED EDUCATION: Bachelor's degree in marketing or healthcare administration.

REQUIRED EXPERIENCE:

• 5-10 years' experience in business development, community relations or health care related activities.

• 3 years Managed-Care, Medicaid experience; knowledge of advertising requirements pertaining to the Medicaid and Medicare media campaigns.

• Prior work experience in a supervisory capacity, demonstrating excellent organizational, prioritizing, and motivational skills.

• Experience in negotiation, sales or marketing techniques.\

PREFERRED EXPERIENCE:

• Previous healthcare enrollment, marketing and/or sales experience.

• Fluency in a second language highly desirable.

• Prior demonstrated work experience in a managerial capacity.

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

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

• Active Life & Health Insurance

• Marketplace Certified

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

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

Key Words: CHIP, Medicare, Medicaid, Duals, Covered, Iowa, Star Plus, SDOH, community, health coach, community health advisor, non-profit, nonprofit, family advocate, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter and public health aide, community lead, community advocate, nonprofit, non-profit, social worker, housing counselor, human service worker, Sales, Navigator, Assistor, Connecter, Promotora, Marketing, Growth, Manager, Supervisor, Leader, Management, Health and Human Services, Iowa HHS, Provider Services, FQHC, Federally Qualified Health Center, Health Link, Care Connect

Pay Range: $59,810.6 - $129,589.63 / 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

Employees for this role will work remotely anywhere in the US.

Job Summary

The Sr Auditor, Delegation Oversight will independently perform audits of multi-delegated functions with minimal oversight and expertise in at least one functional area of auditing. Ensures continuous compliance with Program Integrity requirements (e.g., Monitoring of Exclusion Databases, and Mandatory Employee Trainings) of Molina Health Plan, NCQA, CMS and State Medicaid entities.

Job Duties

• Oversees Utilization Management, Claims, Organizational Credentialing, and Crisis Call Center delegated activities.

• Leads and performs pre-delegation, annual audits, ensuring all components of audit activities comply with NCQA, State and Federal requirements

• Lead external collaborative with other agencies in providing oversight of Behavioral Health Administrative Service Organization for monitoring and auditing of Crisis Lines, Utilization Management, and Organizational Credentialing.

• Ensure that all external partners in the collaborative are assigned to BHASO audits and are completing audits timely.

• Conducts focused audits on subcontractors, as applicable, documenting the outcomes and making recommendations as necessary for further action.

• Conducts analysis of audit issues to identify root cause, develop and issue corrective action plans.

• Build and grow internal and external partnerships to continue team approach to delegate support.

• Prepares, tracks and provides audit reports in accordance with departmental requirements.

• Prepare, submit and present audit reports to Delegation Oversight Committees.

• Presents audit findings to subcontractors and makes recommendations for improvements based on audit results.

• Works with Delegation Oversight Management to develop and maintain assessment tools.

• Update delegates on all Contracting, Federal and State guidelines related to their delegated responsibilities

• Complete all mandatory compliance training annually or as required by leadership.

Job Qualifications

REQUIRED EDUCATION : Bachelor's Degree or equivalent, combination of education and experience

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

• Minimum three years Delegation Oversight experience.

• Minimum two year auditing or utilization review 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.

Pay Range: $49,430.25 - $107,098.87 / 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

Lead Systems Analyst, TCIM - Tech Support, Data Analytics, Emerging technologies

Job Description

The Technical Systems Analyst will be responsible for the design and development of moderate to complex SSIS solutions. Additionally, this role will require the development of automated operational reports and dashboards utilizing Power BI and SQL Server Reporting Services. The position requires three-five years' experience with tools and systems utilizing the Microsoft SQL BI Stack including SSIS, SSRS, TSQL, Power Query, MDX, PowerBI, and DAX. The role is also slated to help understand, design, research and work on emerging technologies.

Knowledge/Skills/Abilities

• Strong knowledge of SQL Server, SSIS and t-SQL, preferably on Azure and/or SQL 2016+ Proven ability to architect and develop solutions which perform data transformations using Microsoft SSIS/SQL ETL tools

• Design and develop SQL Server stored procedures, functions, views and triggers

• Design, implement and maintain SQL database objects (tables, views, indexes) and database security

• Debug and tune existing SSIS/ETL processes to ensure accurate and efficient movement of processed data

• Design, develop and maintain reports and dashboards in Power BI and SQL Server Reporting Services (SSRS).

• Ability to author reports having multiple data sources, complex queries, views, stored procedures, and automation features.

• Assist with database performance optimization and interoperability issues

• Collaborate with Product Owners to elicit and document business requirements for ETL and report design.

• Ability to translate business requirements into sound technical specifications

• Research issues and sets up proof of concept tests

• Support quality acceptance testing which includes the development and/or refinement of test plans

• Lead design review session with scrum team to validate requirements

• Troubleshoot data quality issues and defects to determine root cause

• Strong knowledge of writing BRD's.

• 5+ years software development experience with 3+ years SQL programming utilizing SSIS/SSRS and Power BI

• Experience working with Azure SQL Database, DevOps, GIT and Continual Integration (CI)

• Knowledge and/or experience of the Agile framework and working in a scrum team

• Basic to intermediate knowledge of C#

• Familiarity with healthcare data and concepts

• Familiarity with QNXT

• Excellent analytical and problem-solving abilities

• Strong written and oral communication skills

• Must be able to coach and mentor junior resources within the team.

Required Education

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

Pay Range: $65,791.66 - $142,548.59 / ANNUAL

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

The Care Connections Representative primary focus is to conduct outbound calls to Molina members and schedule appointments with our Nurse Practitioners. As part of Molina's benefit package, the appointments are for preventive care services delivered in the home, community, and nursing facility settings.

Job Duties

• Conduct outbound calls to Molina members and schedule appointments with our Nurse Practitioners

• Understands and strives to meet or exceed call center metrics while providing high quality consistent customer service

• Removes barriers for member's, escalating high impact member issues

• Perform timely documentation in electronic medical record and provide daily audits and feedback

• Accurately schedule appointments to meet all key metrics based on individual scripts, Care Connections, state, and company goals,

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

• Participate in special projects as assigned

• Other duties as assigned

JOB QUALIFICATIONS

Required Education

• High School Diploma or equivalency

Required Experience/Knowledge/Skills/Abilities

• Excellent customer service, active listening, verbal and written communication skills, professional phone voice.

• Working knowledge of Microsoft Office (Outlook, Word, Excel) or other comparable software

• Strong phone and verbal communication skills along with active listening

• Ability to multi-task, set priorities, high ability to pivot with change in strategy and manage time effectively.

• Problem solving skills.

• Attention to detail.

• Bilingual (English/Spanish, Chinese, Korean or Vietnamese)

Preferred Education

• Associate's degree or equivalent combination of education and experience

Preferred Experience

• Customer Service/Call Center experience in health care or equivalent related

• Experience doing outbound appointment setting or similar services

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

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

#PJHS

Pay Range: $12.19 - $26.42 / 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

Supporting the OH Plan, the candidate will act as a liaison to our state regulator on Encounters as well as lead various other technical programs under the OH Operations Department. These currently include support of provider data requirements, vendor data interfaces, Ohio Dept of Medicaid data interfaces, and be a technical resource that can liaison between OH Operations Dept and IT teams. Must be a self-starter willing to learn. Must be a good communicator, comfortable speaking up in group discussions and love work collaboratively with other teams and with senior leadership. This role involves research, root cause analysis, sharing recommendations, analyzing reports and other duties as specified.

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

KNOWLEDGE/SKILLS/ABILITIES

• Develops, implements and uses software and systems to identify issues in data sourced from state and federal agencies and loaded to internal systems.

• Identify data trends.

• Good knowledge of EDI X12 Transactions such as 834, 835, 837, etc.

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

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

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

• Encourages cooperative interactions between cross functional teammates.

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

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

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

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

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

• 7+ years of business analysis experience,

• 6+ years managed care experience.

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

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

• 6+ years experience working as a data or business analyst

• Experienced in developing ad-hoc and standard reports using SQL and Azure Databricks or similar tools to perform analysis on member enrollment data

• Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.

Preferred License, Certification, Association

QNXT or similar healthcare payer applications

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: $59,810.6 - $129,589.63 / 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 Member Navigator primary function is to be the member's liaison. Primarily telephonic, this role is responsible for ensuring that the members member has assistance they may need in navigating their health care needs. Throughout the duration of services, the Member Navigator will communicate with members and caregivers to uncover and act on possible barriers to a healthy outcome, thereby safeguarding against unnecessary admissions, readmissions, urgent care, and emergency department visits.

KNOWLEDGE/SKILLS/ABILITIES

• Strong working knowledge of medical terminology and healthcare landscape preferred

• Excellent written and verbal communication skills to collaborate internally and externally with members, providers, team members, and manager

• Work in an independent manner with minimum supervision

• Excellent problem solving, critical thinking, and organizational skills

• Must be organized and able to prioritize, plan, and handle multiple tasks simultaneously

• Serve as the member's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures

• Make all member welcome calls on date of notification of assignment and/or discharge. Make appropriate and timely member appointments, confirmations, and appointment reminders. Mail letters as needed

• Complete telephonic visits with members utilizing current standard operating procedures

• Notify all appropriate departments of data related member case updates

• Outreach to members/members providers and input appointments

• Adhere to established guidelines for case closings

• Identify and connect member to resources for addressing Social Determinants of Health (SDOH) by utilizing resources from the Health Plan and Aunt Bertha

• Outreach to the appropriate party to report any benefit, authorization, claim or eligibility related issue

• Prepare information for member case status summaries, success stories, etc. and participate in daily huddles, weekly meetings, and other scheduled events, internally, and with members externally

• Prepare, communicate, and follow through on member issues that require escalation communications to management

• Conduct and collaborate on creating action plans for member barriers

• Review system related tasks and email instructions throughout the day for management of daily responsibilities to manage all assigned member cases effectively and thoroughly to completion

• Maintain member outreach and daily activities for cases assigned to out of office Member Navigators and peers as directed by leadership team

• Document accurately all phone calls, interventions, appointments and other system related data member concerns, questions, or complaints

• Consistently meet position Key Performance Indicator metrics as defined by leadership

• Other duties as assigned by leadership may exist to meet business needs.

• Bilingual (English/Spanish, Vietnamese, Chinese)

JOB QUALIFICATIONS

Required Education

High School Diploma or GED required

Required Experience

2+ years of customer service and/or healthcare experience in a fast-paced environment

Preferred Education

Associate Degree or higher from an accredited college preferred

Preferred Experience

• Computer proficiency to include typing, data entry, internet research, and spelling accuracy

• Proficient with Microsoft Office applications including Word, Excel and PowerPoint

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

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

#PJCorp

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