Molina Healthcare Jobs in Long Beach - Page 4

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Job Summary Serves as a subject matter expert in the effective and efficient implementation and administration of Medicare benefits. Responsible for analyzing compliance and business requirements in order to ensure the successful implementation of Medicare mandatory and supplemental Part C benefits and Part D pharmacy benefits. Essential Functions This position exercises independent judgment on co...
Job Summary Perform daily audits on processed claims to ensure payment accuracy. Compile and report audit findings. Essential Functions • Collects claims sample data from system to perform audits. • Evaluates the adjudication of Medicaid claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste,...
Location: Long Beach, CA (this is a non-remote position) Job Summary Healthcare Analyst II is an individual contributor role that provides senior-level healthcare analysis for the state health plans, including quantification and analysis of health care costs, development and maintenance of databases and other sources of information for quality initiatives, accreditation efforts, and regulatory man...
Case Management III Job Summary Responsible for health care management and coordination of Molina Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes. Works with members to create and implement an integrated collaborative plan of care. Coordinates and monitors Molina member's progress and services to ensure consistent cost effective care that complies wi...
Job Summary Directs all aspects of healthcare analysis/reporting for Plan and works directly with Senior Leadership on strategic planning initiatives for reducing costs, improving premium, and increasing membership. Key liaison with Corporate IT in defining data requirements and interactions to meet MHM health plan needs while accommodating system functionality and resources. Essential Functions•...
Job Summary The Director of HEDIS is a key quality leader within the organization. This person is empowered to advise senior management and other departments on HEDIS calculation and reporting and how it relates to initiatives like STAR ratings, NCQA Accreditation, State P4P initiatives, other State performance requirements, clinical interventions and procurement. Essential Functions • Works with...
Job Summary The Corporate Recruiter is responsible for providing excellent staffing services to Molina leaders and associates. Delivers high quality professional level candidates and advances the Molina brand across numerous markets and professional communities, while guiding hiring managers and candidates through the Molina selection process. Perform full lifecycle recruiting and maintain excelle...
Job Summary Resolves issues and problems encountered in day-to-day claims processing, auditing and recovery. Is recognized by management and staff as an expert in issues related to claims processing, payment dispute resolution, cost containment, audit processes, recovery functions and contract interpretation. Plays a key role in training, problem resolution, work floor optimization and process imp...
Job Summary Create and maintain reports supporting all functional areas of claims production, adjustments, recoveries, auditing, compliance and KPI. Ability to work closely with all levels of management to determine business requirements. Proactively perform analysis of data and provide management with concise summary and recommendations if appropriate. Familiar with software life cycle and workin...

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