Molina Healthcare
Job Description Job Summary The Manager, Business Development, Facilitated Enrollments, is responsible for for overseeing daily operations and driving individual and team performance. The Manager will lead a team of Facilitated Enrollers in a designated region(s) making data informed decisions…
JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid…
JOB DESCRIPTION Opportunity for an experienced Care Manager to join the LTSS team Black Hawk County, IA service delivery area. Applicants need to reside within the county. Responsibilities include conducting face to face visits with our Medicaid members and completing…
Must be Certified in CADC or IADC JOB DESCRIPTION Job Summary Provides support to team responsible for creating program initiatives to support to members in addressing social conditions that impact health outcomes providing education, assistance, resources and best practices to…
Job Description Job Summary The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge…
JOB DESCRIPTION Opportunity for a Texas licensed RN to support our Medicaid Members telephonically as part of the Member Outreach Team. Three days a week the members of this team utilize an auto dialer system to make outbound calls to…
JOB DESCRIPTION Job Summary Provides screening, preventive primary care and medical care services to members primarily in non clinical settings where members feel most comfortable, including in home, community and nursing facilities and “pop up” clinics. Strives to ensure member…
JOB DESCRIPTION Job Summary The RN Transition of Care Coach provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from hospital admission to all other settings. Strives to ensure that best possible services are…
JOB DESCRIPTION Job Summary The Program Manager for the Nevada Health Plan provides analytical insights to identify opportunities for improvement in provider and member experience. Provides support to Molina functional areas through program management, including policy, workflow and process documentation,…
JOB DESCRIPTION Job Summary The Marketplace Facilitated Enroller (MFE) is responsible for identifying prospective members that do not have health insurance and assisting with the enrollment process ultimately making it easier for them to connect to the care they need.…
Job Description Job Summary Provide screening of candidates toward identification of qualified, eligible prospects related to both long term care needs and Medicaid coverage for enrollment. Assist our current members with renewing Medicaid coverage and ensure that all program participants…
JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations ensuring members reach desired outcomes through integrated delivery of…
Job Description Job Summary Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set up and a resource for all departments and health plans company wide. Knowledge/Skills/Abilities Conduct interviews with…
Remote and field travel in Chippewa & Eau Claire Counties, WI JOB DESCRIPTION Job Summary Provides support for care management/care coordination long term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across…
Field travel in La Crosse County, Wi JOB DESCRIPTION Job Summary Provides support for care management/care coordination long term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members…
IRIS SDPC (RN) (HOME BASED, NO WEEKENDS/NO AFTER HOURS) Home Health Care, Hospice Care, Palliative Care, Long Term Care, Rehab No weekends, No afterhours support, No holidays Job Description Job Summary Are you seeking a unique nursing position that gives…
IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long term health care needs?…
JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost effective member…
JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide…
JOB DESCRIPTION Job Summary Provides support for care management/care coordination long term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high need potential. Strives to ensure…
Molina Healthcare of Idaho is hiring for a Community Connector. This role will be remote with up to 25% of local travel. Candidates must live in Idaho. Highly qualified candidates will have the following: Healthcare knowledge or background either clinical…
JOB DESCRIPTION Job Summary Provides lead level support for team supporting integrated behavioral health/chemical dependency services and long term care for members with high need potential. In collaboration with multidisciplinary care team working across the continuum, strives to ensure member…
JOB DESCRIPTION Job SummaryProvides support for non clinical healthcare services auditing activities. Responsible for performing audits for non clinical functional areas in alignment with regulatory requirements ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality…
JOB DESCRIPTION Job Summary Provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all…
Remote and must live in Michigan Job Description Job Summary Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall…
JOB DESCRIPTION Job Summary Provides support to Molina functional areas through program management, including policy, workflow and process documentation, management of program controls, vendor practices, budgets, governance frameworks, playbooks and best practices, and champion networks, as applicable. Job Duties Responsible…
JOB DESCRIPTION Job Summary Provides lead level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance for system changes.…
Job Description Job Summary The Distribution Manager at Molina Healthcare will be a critical team member responsible for making Molina a market leader in the different products that Molina offers in the Marketplace and Medicare space. This individual will be…
JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid…
JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations ensuring members reach desired outcomes through integrated delivery of care…
JOB DESCRIPTION Job SummaryProvides non clinical administrative support to the care management function, and contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost effective member…
JOB DESCRIPTION Job Summary The BH Care Manager Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to…
IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long term health care needs?…
ELIGIBILITY SCREENER, TMG Job Description Job Summary TMG is on the lookout for our next great Eligibility Screener! If you love doing meaningful work that helps others live their best lives, we want to hear from you! We’re currently in…
IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long term health care needs?…
IRIS SDPC (RN) (HOME BASED, NO WEEKENDS/NO AFTER HOURS) Home Health Care, Hospice Care, Palliative Care, Long Term Care, Rehab No weekends, No afterhours support, No holidays Job Description Job Summary Are you seeking a unique nursing position that gives…
IRIS SDPC (RN) (HOME BASED, NO WEEKENDS/NO AFTER HOURS) Home Health Care, Hospice Care, Palliative Care, Long Term Care, Rehab No weekends, No afterhours support, No holidays Job Description Job Summary Are you seeking a unique nursing position that gives…
IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long term health care needs?…
IRIS SDPC (RN) (HOME BASED, NO WEEKENDS/NO AFTER HOURS) Home Health Care, Hospice Care, Palliative Care, Long Term Care, Rehab No weekends, No afterhours support, No holidays Job Description Job Summary Are you seeking a unique nursing position that gives…
JOB DESCRIPTION Job Summary Leads and supervises a regionally based team of The Management Group's (TMG) IRIS consultants ensuring provision of high quality, person centered supports to IRIS participants, and achievement of TMG's organizational goals. Contributes to overarching strategy to…
JOB DESCRIPTION Job Summary Provides administrative support for Wisconsin IRIS program operations, including referrals, enrollment, eligibility, service authorization and other administrative related requirements of the IRIS program. Contributes to overarching strategy to provide quality and cost effective care. Essential Job…
IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long term health care needs?…
IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long term health care needs?…
JOB DESCRIPTION Job Summary Provides support for care management/care coordination long term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high need potential. Strives to ensure…
IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long term health care needs?…
JOB DESCRIPTION Job Summary Provides general administrative support that includes routine document preparation, file management, scheduling/arranging meetings, arranging travel and ordering office supplies. May also perform a variety of activities in support of the functional processes, programs and/or services. Also…
Job Description Job Summary Assist business teams with developing requirements for major projects of considerable complexity, prepares system design specifications, conducts research to resolve customer initiated issues related to core systems processing, and coordinates and manages project teams in the…
Remote and must live in San Diego County Job Description Job Summary Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values,…
California residents preferred. Candidates who do not live in California must be willing to work Pacific Time Zone hours. JOB DESCRIPTION Job Summary Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions:…
California residents preferred. Candidates who do not live in California must be willing to work Pacific Business Hours. JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and…
*Nevada residents preferred. Candidates who do not live in NV must become NV licensed if hired JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with…
*Nevada residents preferred. Candidates who do not live in NV must become NV licensed if hired JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with…
New Mexico residency required. JOB DESCRIPTION Job Summary Provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from hospital admission to all other settings. Strives to ensure that best possible services are available to…
JOB DESCRIPTION Job Summary Provides lead level clinical support to healthcare services team supporting one or more of the following functions: care management, utilization management, care transitions, long term services and supports (LTSS), behavioral health, and other clinical programs, and…
JOB DESCRIPTION JOB SUMMARY: Provides support for coordination of benefits review activities that directly impact medical expenses and premium reimbursement. Responsible for primarily coordinating benefits with other carriers responsible for payment. Facilitates administrative support, data entry, and accurate maintenance of…
JOB DESCRIPTION Job SummaryLeads and supervises a team supporting non clinical healthcare services activities for care management, care review, utilization management, transitions of care, behavioral health, long term services and supports (LTSS), and/or other program specific service support ensuring members…
JOB DESCRIPTION Job Summary The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations ensuring members reach desired…
JOB DESCRIPTION Job Summary Provides medical assistant support for Care Connections team. Responsible for contacting members following appointments/services rendered to ensure member understanding and navigation of the health care system, and coordination support for follow up care. Also provides assistance…
JOB DESCRIPTION Job Summary The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations ensuring members reach desired…
JOB DESCRIPTION Job Summary Provides support for care management/care coordination long term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high need potential. Strives to ensure…
JOB DESCRIPTION Job Summary Provides support for care management/care coordination long term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high need potential. Strives to ensure…
JOB DESCRIPTION Job Summary The Molina Healthcare Internship Program shares an objective to create a stepping stone for students who aim to be professionals and future leaders in the healthcare business profession. Interns are assigned special projects and various other…
Job Description Job Summary The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge…
JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations ensuring members reach desired outcomes through integrated delivery of care…
JOB DESCRIPTION Job Summary Lead financial analysis for the Iowa market, focusing on both internal and external reporting. Identify and research financial trends and opportunities to support strategic decision making. Evaluate business opportunities, investment options, and regulatory changes, providing actionable…
JOB DESCRIPTION Job Summary Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information,…
JOB DESCRIPTION Job SummaryProvides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost effective member care. Essential Job Duties Handles and…
JOB DESCRIPTION Training Start Date: 12/1/2025 Shift: 10:30am 7:00pm CST 11:30am 8pm EST During the upcoming open enrollment period, which runs from October 1st through March 31st. During this time, there will be a rotation schedule in place for weekend…
Remote and must live in San Diego County Job Description Job Summary Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values,…
JOB DESCRIPTION Job Summary Provides support for care management/care coordination long term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high need potential. Strives to ensure…