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Results based on filters ( 22 jobs found )

Transition of Care Coach LPN, LCSW or LMSW Remote with field travel in King County

Affinity Health Plan
Washington
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JOB DESCRIPTION Job Summary Molina Healthcare Services (HCS) works with ...
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Summary
About the job:
members, providers, and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. We are seeking a candidate with a WA state LPN, LCSW or LMSW licensure to support our...
Location:
Washington
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Social Workers
Career Level / Education:
Master's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Affinity Health Plan
Certifications / Licenses:
Certified Case Manager
Licensed Clinical Social Worker
Licensed Professional Clinical Counselor
Licensed marriage and family therapist
Licensed Master Social Worker
Licensed Professional Counselor
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

UM LVN Delegation Oversight Nurse Remote based in CA

Affinity Health Plan
Long Beach, CA
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JOB DESCRIPTION Job Summary The Delegation Oversight Nurse is responsible ...
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Summary
About the job:
for ensuring that Molina Healthcare's UM delegates are compliant with all applicable State, CMS, and NCQA requirements, as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the team. We are looking for LVN's with at least 4 years of UM experience, NCQA accreditation, and knowledge of InterQual / MCG guidelines. Excellent computer knowledge, multi-tasking skills and analytical thought process is important to be...
Location:
Long Beach, CA
Job Type:
Full-Time
Permanent
Occupation:
Licensed Practical and Licensed Vocational Nurses
Career Level / Education:
Postsecondary nondegree award
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Affinity Health Plan
Certifications / Licenses:
Certified Case Manager
Certified Professional in Healthcare Quality
Licensed Practical Nurse
Licensed Vocational Nurse
Certified Registered Nurse
Certified Professional In Healthcare Management
National Committee for Quality Assurance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Assoc Specialist, Corp Credentialing

Affinity Health Plan
Arizona
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JOB DESCRIPTION Job Summary Molina's Credentialing function ensures that the ...
Details
Summary
About the job:
Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level...
Location:
Arizona
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
Middle Income Jobs ($30K-$49K)
From:
Affinity Health Plan
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Provider Contracts Manager

Affinity Health Plan
Seattle, WA
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Remote and must live in Washington*** Job Description Job Summary Molina ...
Details
Summary
About the job:
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 mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for contracting/re-contracting of standard deals, maintaining network adequacy, issue escalations and JOCs on exception, including standardized fee for service and other...
Location:
Seattle, WA
Job Type:
Full-Time
Permanent
Occupation:
Business Operations Specialists, All Other
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Affinity Health Plan
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Specialist, Claims Recovery

Affinity Health Plan
Arizona
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Specialist, Claims Recovery AZ, United States and 89 more Trending Job ...
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Summary
About the job:
Description JOB DESCRIPTION Job Summary Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider compliance. Interacts with health plans and vendors regarding recovery outstanding overpayments. Job Duties - Prepares written provider overpayment notification and supporting documentation such as explanation of benefits, claims and attachments. -...
Location:
Arizona
Job Type:
Full-Time
Permanent
Occupation:
Claims Adjusters, Examiners, and Investigators
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Affinity Health Plan
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Assoc Specialist, Corp Credentialing (Remote)

Affinity Health Plan
Arizona
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Molina Healthcare is hiring for a Corporate Credentialing Associate ...
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Summary
About the job:
Specialist . This role is remote and can be worked from a variety of locations within the US. This position processes the credentialing and recredentialing applications for practitioners and facilities that would like to be in the Molina Healthcare network of providers. They verify licensure, DEA, work history, professional liability insurance, training, board certification, etc. We support all LOBs. Highly Qualified Candidates Will Have the Following Experience- - Excellent critical thinking skills - The ability to work...
Location:
Arizona
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
Middle Income Jobs ($30K-$49K)
From:
Affinity Health Plan
Certifications / Licenses:
Board Certified
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Lead, HCS (Non-Clinical) - Medicare

Affinity Health Plan
Arizona
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JOB DESCRIPTION Lead for Healthcare Services will be supporting a team of ...
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Summary
About the job:
Care Review Processor supporting our Medicare line of business. This role will require working as Subject Matter Expert as well as training staff. This is a remote role, home office with internet connectivity of high speed required. Monday – Friday 8 AM to 5 PM (Resident Time Zone) – ability to cover Saturday/Sundays every 6 weeks) Job Summary Molina Healthcare Services (HCS) Department works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of...
Location:
Arizona
Job Type:
Full-Time
Permanent
Occupation:
Compensation, Benefits, and Job Analysis Specialists
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Affinity Health Plan
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Mgr, Sales Operations (Remote)

Affinity Health Plan
Arizona
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Job Description Job Summary The Manager, Sales Operations will be key to the ...
Details
Summary
About the job:
success of the Sales Support Organization by providing strategy, oversight and implementation of our operational activities and process improvements. Job Duties • Oversee strategy, creation, implementation and maintenance of program documentation and policies and procedures, including effective communication of program status to key stakeholders • Ensure performance and identification of process efficiencies, partner with business owners to effectuate change • Lead team of Sales Operations Specialists to elevate...
Location:
Arizona
Job Type:
Full-Time
Permanent
Occupation:
General and Operations Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Affinity Health Plan
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Senior Analyst, Quality Analytics & Performance Improvement - Power BI/SQL/Hedis - Remote

Affinity Health Plan
Arizona
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Senior Analyst, Quality Analytics & Performance Improvement - Power ...
Details
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About the job:
BI/SQL/Hedis - Remote AZ, United States and 89 more Job Description Job Description Job Summary The Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcome. Assist with research, development, and completion of special performance improvement projects. ESSENTIAL JOB DUTIES: - Work cross functionally with various departments to capture and...
Location:
Arizona
Job Type:
Full-Time
Permanent
Occupation:
Business Intelligence Analysts
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Affinity Health Plan
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Intern

Affinity Health Plan
Arizona
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Intern AZ, United States and 89 more Job Description JOB DESCRIPTION Job ...
Details
Summary
About the job:
Summary The Molina Healthcare Internship Program shares an objective to create a steppingstone for students and alumni who aim to be professionals and future leaders in the healthcare business profession. We aim to develop talent by providing students and alumni with experiential learning, formal training, and opportunities to interact with healthcare business professionals who will act as intern managers along the way. KNOWLEDGE/SKILLS/ABILITIES - Ability to abide by Molina's policies - Ability to maintain attendance to...
Location:
Arizona
Job Type:
Part-Time
Internship
Occupation:
Community and Social Service Specialists, All Other
Career Level / Education:
Bachelor's degree
Salary:
Middle Income Jobs ($30K-$49K)
From:
Affinity Health Plan
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information
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