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Specialist, Appeals & Grievances

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Responsible for reviewing and resolving member ...
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Summary
About the job:
and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid KNOWLEDGE/SKILLS/ABILITIES - Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Molina members, providers and related outside agencies to ensure that internal and/or regulatory timelines are met. - Research claims appeals and grievances using...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
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, Appeals & Grievances

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:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Middle Income Jobs ($30K-$49K)
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

Healthcare Services Auditor (RN) (New York)

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job SummaryProvides support for healthcare services clinical ...
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Summary
About the job:
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

Lead Configuration Quality/Audit Analyst

Molina Healthcare, Inc.
Located in Ohio
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Job Description Job Summary Responsible for accurate and timely auditing of ...
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Summary
About the job:
critical information on claims databases. Maintains critical auditing and outcome information. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate accuracy of configuration and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. Responsible for work load assignment to auditors. Train and coach new employees . Provide...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Accountants and Auditors
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

Care Manager, LTSS (RN)

Molina Healthcare, Inc.
Located in Ohio
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For this position we are seeking a (RN) Registered Nurse who must live and ...
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Summary
About the job:
have a current active unrestricted RN license in the state of MI. This position will support our MMP (Medicaid Medicare Population) will be supporting DSNP. This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent computer skills and diligence are especially important to multitask between systems, talk with members on the phone, and enter accurate contact notes....
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 Case Manager
Driver's License
Certified Registered Nurse
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Project Manager, PMO - Medicaid Growth/Jira/Agile - Remote

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Focuses on process improvement, organizational ...
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Summary
About the job:
change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, planning, and issue/risk management. KNOWLEDGE/SKILLS/ABILITIES - Proven depth of understanding and demonstrable results for effective management of intermediate to large-scale projects, using prescribed approach(as). Solid knowledge of methods and techniques involved in project management initiatives. - Able to develop detailed project plans, communication plans, schedules,...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Project Management Specialists
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Molina Healthcare, Inc.
Certifications / Licenses:
Project Management Professional
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

IRIS Consultant (Brown County, WI)

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Do you want a career where you build lasting ...
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Summary
About the job:
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? Then TMG wants to hear from you! We’re currently looking for someone with a social services or human services background to join our team. This is a remote position, where you will partner with people in your community who are enrolled in the Wisconsin IRIS Program and the TMG IRIS Consultant Agency. While your office will be home-based, you will have regularly scheduled visits with...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Social Workers
Career Level / Education:
Master's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
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

Representative, Customer Experience

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Provides customer support and stellar service to ...
Details
Summary
About the job:
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, and identifies opportunities to improve our member and provider experiences. Job Duties • Provide service support to members and/or providers using one or more contact center communication channels and across multiple states and/or products. To include, but not limited to, phone, chat, email, and off phone work...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
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

Care Manager, LTSS

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Provides support for care management/care ...
Details
Summary
About the job:
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, including in-person home visits as required. • Facilitates...
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

Senior Project Manager, PMO - AI/ML - Remote

Molina Healthcare, Inc.
Located in Ohio
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JOB DESCRIPTION Job Summary Focuses on process improvement, organizational ...
Details
Summary
About the job:
change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, planning and issue/risk management. KNOWLEDGE/SKILLS/ABILITIES - Deep understanding of effective project approach(es) for a variety of projects, including projects with a high degree of complexity spanning multiple areas. Able to organize complexity into successfully manageable work plans, estimate staffing requirements (e.g. resource skills & team assembly). - Expert...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Project Management Specialists
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Molina Healthcare, Inc.
Certifications / Licenses:
Project Management Professional
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information
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