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Results based on filters ( 1136 jobs found )

Facilitated Enroller - Benefit Sales Specialist (In Field - Buffalo, NY)

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Provides support for member enrollment ...
Details
Summary
About the job:
activities including identifying, interviewing and screening prospective eligible members for Molina health insurance products, assisting with health plan selection and enrollment processes, processing paperwork and ensuring documentation accuracy and follow-up. Also develops and maintains relationships with local community agencies, health care organizations, and county/state agencies that refer potential eligible members, and represents at community-based outreach events to aid enrollment efforts. Essential Job Duties •...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Insurance Sales Agents
Career Level / Education:
High school diploma or equivalent
Salary:
High Income Jobs ($80K-$99K)
From:
Molina Healthcare, Inc.
Certifications / Licenses:
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

AVP, Quality & Risk Adjustment (Utah)

Molina Healthcare, Inc.
Located in Ohio
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Job Description Job Summary The AVP, Quality & Risk Adjustment is ...
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Summary
About the job:
responsible for leading health plan execution for Risk Adjustment and Quality for all lines of business, ensuring alignment of strategy and activities with Enterprise, acting as the Risk Adjustment and Quality subject matter expert for the health plan. The AVP leads a plan with a large membership base, large population, and multiple lines of business. The plan has complex state requirements. Job Duties - Serves as the primary contact to State agencies for all Risk and Quality matters. - Leads the local Quality committees. -...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
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

Specialist, Appeals & Grievances (Member appeals experience)

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Provides support for claims activities including ...
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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:
Claims Adjusters, Examiners, and Investigators
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

Specialist, Pharmacy Operations (Medicaid/ PBM experience)

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job SummaryProvides support for pharmacy delegated service ...
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Summary
About the job:
activities. Responsible for implementation of new products/services and existing business management. Contributes to overarching pharmacy strategy of optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job Duties • Supports designated lines of business surveillance and oversight of delegated functions. • Analyzes and interprets data to identify erroneous execution of the pharmacy benefit by the Pharmacy Benefit Manager (PBM). • Reviews daily inventory of “outliers”...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
Career Level / Education:
Bachelor's degree
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

Market CFO, CA Health Plan – Remote

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Looking for an individual ready for a fast-paced ...
Details
Summary
About the job:
environment. This individual will provide executive level strategy and leadership for market finance activities - specifically provision of financial analysis to support business decisions including profitability initiatives for medical management metrics, member growth/retention ventures, targeted business extensions/expansions, rate advocacy efforts and other activities involving the finance function. Provides subject matter expertise and collaboration on enterprise projects and priorities including standardization...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Financial and Investment Analysts
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Molina Healthcare, Inc.
Certifications / Licenses:
Certified Public Accountant
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Senior Analyst, Data

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Designs and implements processes and solutions ...
Details
Summary
About the job:
associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and unstructured data from multiple disparate sources. Collaborates across departments and with customers to define requirements and understand business problems. Uses advanced mathematical, statistical, querying, and reporting methods to develop...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
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

Lead, Medicare Administration (Bids & Member Materials) (Remote)

Molina Healthcare, Inc.
Located in Ohio
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Molina Healthcare is hiring a Lead, Medicare Administration . This will be a ...
Details
Summary
About the job:
remote position on our team that is responsible for our Medicare product- both Bids and Member Materials. Highly qualified candidates will have the following experience: - Medicare experience - Experience filing bids - In depth understanding of planning benefits - Experience with member materials - Product management, product development of the Medicare product - Experience supporting annual Medicare Product Management Life Cycle (applications, bids, benchmarking, mandated member materials) - Full understanding of MS...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
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

Auditor, Healthcare Services (RN)

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Provides support for healthcare services ...
Details
Summary
About the job:
clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Molina Healthcare, Inc.
Certifications / Licenses:
Certified Registered Nurse
National Committee for Quality Assurance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Senior Specialist, Health Plan Communications

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job SummaryProvides senior level support for health plan ...
Details
Summary
About the job:
communications and marketing activities. Responsible for developing internal and external brand aligned communications and marketing campaigns, including marketing and communications materials for member and employee audiences, and ensuring all state/federal regulatory, accreditation, and internal requirements are met for health plan communications and materials. Essential Job Duties • Writes and develops content to support the creation of internal and external communication and marketing materials. • Edits, proofs and...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Public Relations Specialists
Career Level / Education:
Bachelor's degree
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

Care Manager, LTSS - Field travel in La Crosse County, WI

Molina Healthcare, Inc.
Located in Ohio
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***Remote with frield travel for member visits in La Crosse County*** JOB ...
Details
Summary
About the 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 member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive member assessments within regulated timelines,...
Location:
Located in Ohio
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:
Molina Healthcare, Inc.
Certifications / Licenses:
Certified Case Manager
Driver's License
Licensed Vocational Nurse
Licensed Practical Nurse
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information
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