Company Detail

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

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 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

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

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

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

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

Quality Improvement, HEDIS, Healthcare experience is very important for this position. Candidates with these skills will receive first consideration. Please identify this experience on your resume.

KNOWLEDGE/SKILLS/ABILITIES

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

• Acts as a lead specialist to provide project-, program-, and / or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments.

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

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

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

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

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

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

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

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

JOB QUALIFICATIONS

Required Education

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

Required Experience

• Min. 3 years' experience in healthcare with minimum 2 years' experience in health plan quality improvement, managed care or equivalent experience.

• Demonstrated solid business writing experience.

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

Preferred Education

Preferred field: Clinical Quality, Public Health or Healthcare.

Preferred Experience

• 1 year of experience in Medicare and in Medicaid.

• Experience with data reporting, analysis and/or interpretation.

Preferred License, Certification, Association

• Active, unrestricted Certified Professional in Health Quality (CPHQ)

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

• Active, unrestricted Certified HEDIS Compliance Auditor (CHCA)

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.

#PJQA

#LI-AC1

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

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

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

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

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

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

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

Quality Improvement, HEDIS, Healthcare experience is very important for this position. Candidates with these skills will receive first consideration. Please identify this experience on your resume.

KNOWLEDGE/SKILLS/ABILITIES

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

• Acts as a lead specialist to provide project-, program-, and / or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments.

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

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

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

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

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

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

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

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

JOB QUALIFICATIONS

Required Education

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

Required Experience

• Min. 3 years' experience in healthcare with minimum 2 years' experience in health plan quality improvement, managed care or equivalent experience.

• Demonstrated solid business writing experience.

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

Preferred Education

Preferred field: Clinical Quality, Public Health or Healthcare.

Preferred Experience

• 1 year of experience in Medicare and in Medicaid.

• Experience with data reporting, analysis and/or interpretation.

Preferred License, Certification, Association

• Active, unrestricted Certified Professional in Health Quality (CPHQ)

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

• Active, unrestricted Certified HEDIS Compliance Auditor (CHCA)

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.

#PJQA

#LI-AC1

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 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

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

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

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

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

Case Manager needed in the Canton, TX service area. Applicants must reside in this community or surrounding communities and hold a TX RN license in good standing to be considered. Our field case managers complete assessments with the members face-to-face in their homes. Applicants with Case Manager experience with another MCO like Molina are preferred, but we will also consider candidates who have a strong background in home health/hospice. The schedule is Monday - Friday, 8 AM - 5 PM CST. Mileage is reimbursed through our benefits program.

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

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

• Facilitates comprehensive waiver enrollment and disenrollment processes.

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

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

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

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

• Evaluates covered benefits and advise appropriately regarding funding source.

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

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

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

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

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

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

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

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

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

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

• Required License, Certification, Association

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

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

State Specific Requirements

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

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

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

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

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

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

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

Pay Range: $23.76 - $51.49 / HOURLY

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

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

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

KNOWLEDGE/SKILLS/ABILITIES

• Completes 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

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 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

JOB DESCRIPTION

Family Care with My Choice Wisconsin

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:

• 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.

#PJHS

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

Family Care with My Choice Wisconsin

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:

• 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.

#PJHS

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

Family Care with My Choice Wisconsin

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:

• 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.

#PJHS

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