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Jobs at Molina Healthcare

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Medical Records Collector

Molina Healthcare - Long Beach, CA

Job Description Job Summary Molina's HEDIS/Quality Improvement Medical Records Collector will work collaboratively in outreaching to providers in order to pursue medical records via phone call, fax, mail, electronic medical record system retrieval and direct onsite pick up, for the HEDIS projects. Knowledge/Skills/Abilities • Under the direction of ...

AVP, Community & Member Engagement

Molina Healthcare - Bothell, WA

Job Description Job Summary Responsible for achieving established goals improving Molina's enrollment growth objectives encompassing all lines of business. Works collaboratively with key departments across the enterprise to improve overall choice rates and assignment percentages. Knowledge/Skills/Abilities • In partnership with executive leadership,...

Assoc Rep, Provider Appeals & Disputes

Molina Healthcare - Bothell, WA

Job Description Job Summary Molina Health Plan Operations jobs are responsible for the development and administration of our State health plan's operational departments, programs and services, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provide...

Care Review Clinician, Inpatient Review RN (Remote)

Molina Healthcare - Albuquerque, NM

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 desir...

Credentialing Clerk

Molina Healthcare - Spokane, WA

Job Description Job Summary Clerks are responsible for entering credentialing information received from practitioners and providers into our credentialing database. Clerks work on a team that supports each other through various functions to ensure team goals are achieved. Job Functions: Complete data entry of applications in the cred...

Sr. Abstractor, HEDIS/Quality Improvement

Molina Healthcare - Milwaukee, WI

Job Description Job Summary Molina's Quality Improvement Sr. Abstraction team functions to conduct data collection and abstraction of medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The abstraction team will meet chart abstraction productivity standards as well as minimum over read standards. Knowledge/Skills/Abili...

Case Manager (Bilingual in Spanish)

Molina Healthcare - Long Beach, CA

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 desir...

Specialist, Appeals & Grievances (REMOTE)

Molina Healthcare - Long Beach, CA

Job Description Job Summary Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid

Specialist, Appeals & Grievances (REMOTE)

Molina Healthcare - Long Beach, CA

Job Description Job Summary Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid

NICU / PEDS Case Manager - Vancouver, WA

Molina Healthcare - Vancouver, WA

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 desir...

Medical Director, Health Plan (Pediatric)

Molina Healthcare - Louisville, KY

Knowledge/Skills/Abilities Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to Plan members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding ...

Medical Director, Behavioral Health

Molina Healthcare - Louisville, KY

Job Description Job Summary Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs. Knowledge/Skills/Abilities Provides Psychiatric leadership for...

Sr Analyst, Implementation MLTSS (Remote)

Molina Healthcare - Long Beach, CA

Job Description Job Summary Analyzes complexbusinessprocessesusingdatafrominternalandexternalsourcesto provideinsighttodecision-makers.Identifiesandinterpretstrendsandpatterns indatasetstolocate influences.Constructsforecasts,recommendationsandstrategic/tacticalplansbasedonbusinessdata andmarketknowledge.Createsspecificationsforreportsandanalysisbasedonbusinessne...

Case Manager, Idaho (Social Worker or RN)

Molina Healthcare - Idaho Falls, ID

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 desir...

Program Manager MLTSS (Remote)

Molina Healthcare - Long Beach, CA

Job Description Job Summary Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of ext...