Molina Healthcare Jobs & Careers

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44 Molina Healthcare jobs found on Monster.

Jobs 1 to 20 of 44
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 West Allis, WI, 53227
Job Summary Assists the Director with ensuring the Molina Medicaid plans maintain NCQA Accreditation and bring new or acquired plan to NCQA Accredited status. The Manager maintains tracking of State QI activities and ensures timely completion within appropriate Corporate standards. The Manager maintains the library of accreditation and regulatory updates from NCQA, CMS and state regulators. The M...
Molina Healthcare Columbus, OH, 43231
MOLINA HEALTHCARE- SUPERVISOR CASE MANAGER - COLUMBUS, OH Job Summary Responsible for overseeing the Integrated Case Management staff focused on assisting Molina Healthcare members with their health care needs to achieve optimal clinical, financial and quality of life outcomes. Monitors information daily as appropriate including member metrics and staff productivity. Evaluates the services provi...
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 Long Beach, CA
Job Summary Operates in the capacity of a subject matter expert on topics including but not limited to encounter transactions/submission, recovery or claims editing requirements and regulations specific to states in which Molina operates. Researches, verifies and interprets state requirements relating to all aspects of the encounter, recovery and cost savings functions. Develops or modifies inter...
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...
Molina Healthcare Jacksonville, FL
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 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- MANAGER QI COMPLIANCE -HEALTHPLAN (REGISTERED NURSE) Job Summary Manages the local QI Compliance process, including goal setting and monitoring. Essential Functions • Implements goals and directives of HP QI Director for Accreditation, State compliance activities, CMS quality activities and other compliance duties as required • Defines and documents policies and procedures ...
Molina Healthcare Long Beach, CA
Job SummaryResponsible for ensuring Molina compliance with both regulatory and company Information Security policies. Monitors compliance and maintains an awareness of state, federal, and company established Information Security regulations/policies by working with internal Molina staff and vendors to identify and resolve areas of non-compliance. Creates an appropriate level of awareness for these...
Molina Healthcare Columbus, OH
Job Summary Supervises a team of Provider Contract Specialists and Provider Contracts Coordinators to effectively create required contract documents according to standardized policies and procedures, documents all negotiations and implements/oversees tracking systems. Maintains standardized contract tracking system and publishes reports according to departmental procedures. Essential Functions ...
Molina Healthcare West Allis, WI
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. Will also be responsible for the development and manage...
Molina Healthcare Columbus, OH
Job Summary Responsible for gathering, coordinating, and processing of data from the provider network for entry into the Provider Information Management System. Also responsible for development of policies and procedures, tracking of provider data, overseeing projects as requested by Director, Manager, Supervisor or Lead of Provider Network Administration unit. Essential Functions • Oversees re...
Molina Healthcare West Allis, WI
Job Summary Responsible for the accounting/finance functions within Finance department including preparation of Financial Statements, maintenance of GL, analysis and reconciliation of account balances, budget preparation and variance reporting & analysis, reinsurance analysis, PCP capitation processing and analysis, and state required financial reporting. Essential Functions • Prepare financial...
Molina Healthcare Columbus, OH, 43231
MOLINA HEATLHCARE-DIRECTOR OF LONG TERM SERVICES AND SUPPORT-COLUMBUS, OH Job Summary Direct oversight of Long Term Services and Supports (LTSS) programs, both institutional and home and community based, including the development, implementation and outcomes monitoring of long-term support services. This oversight includes the development of clinical and social model programs to meet regulatory ...
Molina Healthcare West Allis, WI
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. Will also be responsible for the development and manage...

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