Molina Healthcare
Molina Healthcare Company Information
Molina Healthcare Company Information
Molina Healthcare Jobs & Careers
220 Molina Healthcare jobs found on Monster.
Molina Healthcare
Columbus, OH
Job Summary Serve as a liaison between Molina and its members. Ensure members receive a level of service that exceeds their expectations. Respond and resolve questions and problems from current/prospective members or their representatives, providers and other appropriate parties within expected standards. Essential Functions • Performs peer review quality assurance checks on eligibility Unit work...
Molina Healthcare
Columbus, OH
Job Summary Leading, with a team, or individually, develops or modifies business requirements and functional specifications for software application and technology projects, including Business Requirements Documents (BRDs) and Functional Requirements Documents (FRDs). . Assists project managers by managing sub-teams or a portion of an overall project. Generally works on medium to large scale proje...
Molina Healthcare
Long Beach, CA, 90802
MOLINA HEALTHCARE - PHARMACY BENEFITS MANAGER Job Summary In collaboration with the MHI's Clinical Pharmacists and under the supervision of the MHI's VP of Pharmacy Services will monitor and manage the operational aspects of the contract between MHI and the PBM (Pharmacy Benefits Manager) to assure contract compliance and maximize the PBM's value to MHI. Essential Functions • Oversee, support and...
Molina Healthcare
Midvale, UT
Job Summary Oversees the integrated Care Access and Monitoring team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Monitors information daily as appropriate including member metrics and staff producti...
Molina Healthcare
Miami, FL
Job Summary Develops materials and compiles documentation for various QI compliance activities. Essential Functions • Writes and formats training and coaching materials • Compiles documentation for NCQA accreditation and other compliance activities • Develops final submissions • Supports research as needed Knowledge/Skills/Abilities Quality Family • Business Acumen (entry level) - Knows how busine...
Molina Healthcare
Miami, FL
Job Summary Responsible for implementing and monitoring local QI and HEDIS interventions. Essential Functions • Assists Interventions Manager in implementing provider or member interventions • Works on removing barriers to care, either at the provider or member level • Assists in data entry and monitoring of interventions • Works with HP Reporting to produce reports on intervention progress and su...
Molina Healthcare
San Antonio, TX
Job Summary Oversees the integrated Care Access and Monitoring team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Monitors information daily as appropriate including member metrics and staff producti...
Molina Healthcare
Troy, MI
Job Summary Provides medical oversight 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. Essential Functions Provides clinical support for all areas of Medical Affairs: • Facilitates conformance to DHS, DMHC, NCQA and othe...
Molina Healthcare
Miami, FL
Job Summary Manages and implements all local QI and HEDIS interventions. Essential Functions The position's essential functions are as follows: • Implements goals and directives of HP QI Director for HEDIS and Interventions • Note: Depending on size of HP, this can be one position or two • HEDIS: Defines and implements HEDIS work plan in consultation with HP QI Director and Corporate HEDIS unit •...
Molina Healthcare
Miami, FL
Job Summary : Responsible for implementing and monitoring local risk adjustment coordination efforts. Essential Functions • Defines and implements HP risk adjustment strategy in conjunction with Corporate Risk Adjustment department and plan QI and Provider Services Directors • Works with Manager, Coding and Education and Manager, Vendor Oversight and CMS Submission to implement appropriate chart r...
Molina Healthcare
Troy, MI
POSITION SUMMARY Subject matter expert and project manager for Medicare initiatives at the health plan. Responsible for driving execution of Molina's quality, compliance, integration and profitability strategy for Medicare dual eligible special needs plans (D-SNPs), in coordination with corporate Medicare. DUTIES AND RESPONSIBILITIES •Provides input on issues of strategic direction to health plan...
Molina Healthcare
Midvale, UT
MOLINA HEALTHCARE - MANAGER HEALTHCARE ANALYSIS POSITION SUMMARY Manager Healthcare Analysis is a supervisory role, responsible for managing plan Healthcare Analysis staff to meet the reporting needs of the health plan. ESSENTIAL FUNCTIONS Duties and Responsibilities • Daily management of plan Healthcare Analysis (HCA) staff. • Allocate new report/project requests (workload distribution). • Coordi...
Molina Healthcare
Boise, ID
Job Summary Leading, with a team, or individually, develops or modifies business requirements and functional specifications for software application and technology projects, including Business Requirements Documents (BRDs) and Functional Requirements Documents (FRDs). . Assists project managers by managing sub-teams or a portion of an overall project. Generally works on medium to large scale proje...
Molina Healthcare
Augusta, ME
Job Summary Considered a SQL GURU. Assists in gathering requirements, technical requirements and works directly with Business Architects within MITA areas. May work independently or cooperatively with other software developers. May act as a lead on smaller projects and roles specific to area of expertise. Essential Functions o Creates stored procedures, functions and queries o Writes and maintains...
Molina Healthcare
Long Beach, CA
Job Summary Oversees the integrated Care Access and Monitoring team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Monitors information daily as appropriate including member metrics and staff producti...
Molina Healthcare
Midvale, UT
Job Summary Oversees the integrated Care Access and Monitoring team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Monitors information daily as appropriate including member metrics and staff producti...
Molina Healthcare
Bothell, WA
MOLINA HEALTHCARE - MEDICAL DIRECTOR (TEMP) Job Summary Provides medical oversight 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. Essential Functions Provides clinical support for all areas of Medical Affairs: • Facilit...
Molina Healthcare
San Antonio, TX
Job Summary Creates and analyzes reports for Interventions team. Essential Functions The position's essential functions are as follows: • Writes reports for Intervention team • Uses peer-to-peer review process and end-user consultation to reduce report writing errors • Produces reports on schedule • Modifies reports in response to error identification • Modifies reports in response to change manag...
Molina Healthcare
Bothell, WA
MOLINA HEALTHCARE - Care Review Clinician II - RN JOB SUMMARY Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalizatio...
Molina Healthcare
Long Beach, CA
Job Summary Responsible for working with business stakeholders, including project management and Technical leads, to translate business requirements into a technical design strategy for implementing the application or solution. Coordinates with Technical leads and developers to implement the application or solution, and shows how the current and future needs of business stakeholders will be met in...
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©2013 Monster - All Rights Reserved U.S. Patents No. 5,832,497; 7,599,930 B1; 7,827,125 and 7,836,060 MWW - Looking for Monster Cable? - V: 2013.1.5.22-209