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Results based on filters ( 2682 jobs found )

Specialist, Appeals & Grievances

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Provides support for claims activities including ...
Details
Summary
About the job:
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 Services (CMS). Essential Job Duties • Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. • Researches claims appeals...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
High Income Jobs ($80K-$99K)
From:
Molina Healthcare, Inc.
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

RN Medical Review Nurse Remote

Molina Healthcare, Inc.
Located in Ohio
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Job Description Job Summary The Medical Review Nurse provides support for ...
Details
Summary
About the job:
medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have strong organizational skills, proficient knowledge of MS...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Health Information Technologists and Medical Registrars
Career Level / Education:
Associate's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Molina Healthcare, Inc.
Certifications / Licenses:
Certified Professional In Healthcare Management
Certified Registered Nurse
ICD-10 / ICD-9
Certified Professional in Healthcare Quality
Certified Case Manager
Certificate of Clinical Competence
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

CORRESPONDENCE PROCESSOR

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Provides support for member correspondence ...
Details
Summary
About the job:
activities. Responsible for generating clinical determination letters for members and providers, and following established guidelines and standards related to correspondence processing. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assists with generating clinical determination letters to members and providers, ensuring all letters are clear, accurate, and meet the required reading grade level. • Collaborates with internal teams to ensure correspondence meets...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Office Clerks, General
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Molina Healthcare, Inc.
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Analyst, Claims Research

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Provides analyst support for claims research ...
Details
Summary
About the job:
activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Essential Job Duties • Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
High Income Jobs ($80K-$99K)
From:
Molina Healthcare, Inc.
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Pharmacy Technician

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Provides support for pharmacy technician ...
Details
Summary
About the job:
activities. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job Duties • Performs initial receipt and review of non-formulary or prior authorization requests against pharmacy plan approved criteria; requests additional information from providers as needed to properly evaluate requests. • Accurately enters approvals or denials of requests. • Facilitates prior authorization requests within established pharmacy policies...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Pharmacy Technicians
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Molina Healthcare, Inc.
Certifications / Licenses:
Certified Pharmacy Technician
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Community Connector (field travel Monroe County, NY)

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job SummaryProvides support for community-based member ...
Details
Summary
About the job:
advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing health care needs. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Engages with members as an advocate and resource to support management of health care needs. • Collaborates with and supports the health care services team by providing non-clinical paraprofessional duties in the field to...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Social and Human Service Assistants
Career Level / Education:
High school diploma or equivalent
Salary:
High Income Jobs ($80K-$99K)
From:
Molina Healthcare, Inc.
Certifications / Licenses:
Certified Medical Assistant
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Community Connector (East Central Counties, IL)

Molina Healthcare
Saint Petersburg, FL
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Job Description JOB DESCRIPTION Job SummaryProvides support for ...
Details
Summary
About the job:
community-based member advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing health care needs. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Engages with members as an advocate and resource to support management of health care needs. * Collaborates with and supports the health care services team by providing non-clinical paraprofessional duties...
Location:
Saint Petersburg, FL
Job Type:
Full-Time
Permanent
Occupation:
Social and Human Service Assistants
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
TalentAlly
Certifications / Licenses:
Driver's License
American Sign Language
Certified Medical Assistant
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Community Connector (Southwest State counties, IL)

Molina Healthcare
Elizabethtown, KY
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Job Description JOB DESCRIPTION Job SummaryProvides support for ...
Details
Summary
About the job:
community-based member advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing health care needs. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Engages with members as an advocate and resource to support management of health care needs. * Collaborates with and supports the health care services team by providing non-clinical paraprofessional duties...
Location:
Elizabethtown, KY
Job Type:
Full-Time
Permanent
Occupation:
Social and Human Service Assistants
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
TalentAlly
Certifications / Licenses:
Driver's License
American Sign Language
Certified Medical Assistant
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Community Connector (Southwest State counties, IL)

Molina Healthcare
Detroit, MI
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Job Description JOB DESCRIPTION Job SummaryProvides support for ...
Details
Summary
About the job:
community-based member advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing health care needs. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Engages with members as an advocate and resource to support management of health care needs. * Collaborates with and supports the health care services team by providing non-clinical paraprofessional duties...
Location:
Detroit, MI
Job Type:
Full-Time
Permanent
Occupation:
Social and Human Service Assistants
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
TalentAlly
Certifications / Licenses:
Driver's License
American Sign Language
Certified Medical Assistant
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Community Connector (South Side Chicago Counties)

Molina Healthcare
Sterling Heights, MI
Actions
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Job Description JOB DESCRIPTION Job SummaryProvides support for ...
Details
Summary
About the job:
community-based member advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing health care needs. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Engages with members as an advocate and resource to support management of health care needs. * Collaborates with and supports the health care services team by providing non-clinical paraprofessional duties...
Location:
Sterling Heights, MI
Job Type:
Full-Time
Permanent
Occupation:
Social and Human Service Assistants
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
TalentAlly
Certifications / Licenses:
Driver's License
American Sign Language
Certified Medical Assistant
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information
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