Molina Healthcare Jobs & Careers

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46 Molina Healthcare jobs found on Monster.

Jobs 1 to 20 of 46
Molina Healthcare Columbus, OH, 43231
MOLINA HEALTHCARE- CASE MANAGER II - COLUMBUS, OH 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...
Molina Healthcare Columbus, OH, 43231
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 hospitalization and/or procedures providing prior authorization...
Molina Healthcare Columbus, OH, 43231
MOLINA HEALTHCARE- CASE MANAGER II (EDD- REGISTERED NURSE) COLUMBUS, OH 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 ...
Molina Healthcare Miami, FL
Job SummaryThe Supervisor will work with the manager of MRR Quality in setting medical records review standards that are to be applied to individual health plan and vendor projects. Essential Functions • Works with the Manager of Quality to set medical records review (MRR) standards for HEDIS for quality assurance purposes; assist with writing P&Ps to document standards for review by external re...
Molina Healthcare Miami, FL
Job Summary Responsibility for complex tasks supporting multiple projects and programs including project tracking, project coordination, data management, document management and distribution via internet and intranet sources. Member and provider outreach and education regarding covered and missing services. Essential Functions• Under the direction of Director of Quality Improvement, organizes an...
Molina Healthcare Columbus, OH, 43231
MOLINA HEALTHCARE- CARE REVIEW PROCESSOR I- COLUMBUS, OH Job Summary Works within the Care Access and Monitoring (CAM) team to provide clerical and data entry support for Molina Members that require hospitalization and/or utilization review for other healthcare services. Checks eligibility and verifies benefits, obtains and enters data into systems, processes requests, and triages members and in...
Molina Healthcare San Antonio, TX
Job Summary Under general supervision/direction, responsible for supporting various provider services functions with an emphasis on working externally with Plan's Providers to educate, advocate and engage as valuable partners. Requires provider services and contracting subject matter expertise. Also responsible for resolving Provider issues that may cross departmental lines and involve Senior Lea...
Molina Healthcare Charleston, SC
Job Summary Review retail level (level I) prior authorization request for approval. Interacts with other staff throughout the organization, as well as external contacts on a daily basis. Ongoing public contacts include, but are not limited to: individual pharmacies, physician offices, and other agencies. Authorized to make and carry out simple prior authorization request on behalf of the pharmacy...
Molina Healthcare San Antonio, TX
Job Summary Responsible for the coordination of the daily work flow of the Administrative Services Department and staff under the direction of the Manager, Administrative Services. Essential Functions • Ensure daily tasks (i.e. provider checks, mailings, inter-office mail pick-up/delivery, fulfillment of health education/disease management material, etc.) are completed accurately and in a timel...
Molina Healthcare Orlando, FL
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 with Molina policy an...
Molina Healthcare Long Beach, CA
Job Summary Responsible for the management of inpatient concurrent review services provided to new born intensive care members with a focus on discharge planning and follow-up for 30 days post discharge to prevent unplanned readmissions. . Functions as a clinical resource for other licensed and non-licensed UM staff, interacts with Medical Directors, Molina staff, providers, and care givers to at...
MOLINA HEALTHCARE- CLINCIAL PHARMACIST, OAKBROOK, IL Job Summary Develops and implements targeted drug utilization and disease state management strategies to deliver high quality, cost effective healthcare. Promotes clinically appropriate prescribing practices based on evidence based medicine and national guidelines through various modalities (provider/plan profiling, member drug profile reviews...
Molina Healthcare Detroit, MI
Job Summary Entry level claims processing and adjudication of fee for service claims (CMS 1500 and basic UB04) and claims research when necessary. Must meet and/or exceed quality and production standards. Essential Functions • Quality Standard - Must meet and maintain the quality rate. • Claims Adjudication - Must meet and consistently maintain production standards. • Teamwork - Rating is bas...
Molina Healthcare Cincinnati, OH, 45240
MOLINA HEALTHCARE- CASE MANAGER II- CINCINNATI, OH 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 cos...
Molina Healthcare Miami, FL
Job SummaryUnder general supervision, is responsible for improving overall quality and completeness of clinical documentation, performs assessments to determine errors in the records. Essential Functions• Initiates and performs concurrent documentation review of selected records to clarify where inadequate or conflicting documentation is suspected. • Escalates errors to Mgr, AVP and VP in timely ...
Molina Healthcare Irving, TX
Job Summary: Responsible for implementing and monitoring local QI and HEDIS interventions. Essential FunctionsThe position's essential functions are as follows: • Coordinates the preparation of annual HEDIS medical records project. • Coordinates medical record collection process with third party vendor and/or MHI. • Validates external data sources to ensure exchange of data (i.e. labs, claims ...
Molina Healthcare Detroit, MI, 48084
SupervisorInsurance Healthcare Claims Process (not billing) Detroit, MI 48084 Directly supervises daily activities/tasks performed by non-exempt and/or exempt employees. Monitors operations of Claims Department unit and actively assists, or provides direction to, subordinates as required using standard policies, procedures and guidelines. Essential Functions • Responsible for the team achieving...
Molina Healthcare Detroit, MI, 48084
Corporate Claims Production CenterManager - 1 openingSupervisors - 2 openings Detroit, MI 48084 Manage daily operation of one or more Claims teams. They are responsible for assuring the achievement and maintenance of departmental key performance indicators as well federal and state specific requirements. Essential Functions • Manage a team of individuals focused on consistently meeting or excee...
Molina Healthcare Spokane, WA
Job SummaryManages an effective provider-credentialing program. Maintains credentialing processes that meet or exceed accreditation standards. Supervises and evaluates credentialing personnel. Facilitates the coordination and integration of utilization, satisfaction, and quality improvement, performance and site review data and information into the credentialing process. Prepares an annual budget ...
Molina Healthcare Salt Lake City, UT
Job Summary Responsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved market areas to achieve stated revenue, profitability and retention goals, while following ethical sales practices and adhering to established policies and procedures. Essential Functions • Develop sales strategies to pro...

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