Nurse Manager jobs at HCA Healthcare

The Manager, Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives improvement change by recommending actionable initiatives to C-level Suite executives to mitigate these trends. Responsible for conducting complex analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities. KNOWLEDGE/SKILLS/ABILITIES Manages and provides direct oversight of Medical Economics Team activities and personnel. Provides technical expertise, manages relationships with operational leaders and staff. Directs staff assigned to their projects, supports health plan market(s) with trend analyses, finding scoreable action items (SAIs) and ad hoc analyses as requested. Responsible for staff time keeping, performance coaching, development, and career paths. Extract and compile information from various systems to support executive decision-making Mine and manage information from large data sources. Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs. Work with clinical, provider network and other personnel to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions. Work with business owners to track key performance indicators of medical interventions Perform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action plan Draw actionable conclusions based on analyses performed, make recommendations through use of healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterprise Analyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making Support Financial Analysis projects related to medical cost reduction initiatives and budgeting same Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare JOB QUALIFICATIONS Required Education Bachelor's Degree in Finance, Economics, Math, Healthcare Management, Computer Science, Information Systems, or related field Required Experience 3 years management or team leadership experience 10 years analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) Strong Knowledge of SQL and PowerBI report development Familiar with relational database concepts, and SDLC concepts Preferred Education Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field. Preferred Experience 3 - 5 years supervisory experience Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans Experience with Databricks Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.) Proficiency with Excel and SQL for retrieving specified information from data sources. Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form) Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. • Understanding of value-based risk arrangements Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. #PJCorp #LI-AC1

The Manager, Medical Economics provides support and consultation to the New York Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives improvement change by recommending actionable initiatives to C-level Suite executives to mitigate these trends. Responsible for conducting complex analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities. KNOWLEDGE/SKILLS/ABILITIES Manages and provides direct oversight of Medical Economics Team activities and personnel. Provides technical expertise, manages relationships with operational leaders and staff. Directs staff assigned to their projects, supports health plan market(s) with trend analyses, finding scoreable action items (SAIs) and ad hoc analyses as requested. Responsible for staff time keeping, performance coaching, development, and career paths. * Extract and compile information from various systems to support executive decision-making * Mine and manage information from large data sources. * Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs. * Work with clinical, provider network and other personnel to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions. * Work with business owners to track key performance indicators of medical interventions * Perform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives * Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action plan * Draw actionable conclusions based on analyses performed, make recommendations through use of healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterprise * Analyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management * Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports * Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes * Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making * Support Financial Analysis projects related to medical cost reduction initiatives and budgeting same * Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results * Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare JOB QUALIFICATIONS Required Education Bachelor's Degree in Finance, Economics, Math, Healthcare Management, Computer Science, Information Systems, or related field Required Experience * 3 years management or team leadership experience * 10 years analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) * Strong Knowledge of SQL and PowerBI report development * Familiar with relational database concepts, and SDLC concepts Preferred Education Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field. Preferred Experience * 3 - 5 years supervisory experience * Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans * Experience with Databricks * Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.) * Proficiency with Excel and SQL for retrieving specified information from data sources. * Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form) * Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. • Understanding of value-based risk arrangements * Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare * To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $88,453 - $206,981 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The Manager, Medical Economics provides support and consultation to the New York Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives improvement change by recommending actionable initiatives to C-level Suite executives to mitigate these trends. Responsible for conducting complex analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities. KNOWLEDGE/SKILLS/ABILITIES Manages and provides direct oversight of Medical Economics Team activities and personnel. Provides technical expertise, manages relationships with operational leaders and staff. Directs staff assigned to their projects, supports health plan market(s) with trend analyses, finding scoreable action items (SAIs) and ad hoc analyses as requested. Responsible for staff time keeping, performance coaching, development, and career paths. * Extract and compile information from various systems to support executive decision-making * Mine and manage information from large data sources. * Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs. * Work with clinical, provider network and other personnel to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions. * Work with business owners to track key performance indicators of medical interventions * Perform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives * Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action plan * Draw actionable conclusions based on analyses performed, make recommendations through use of healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterprise * Analyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management * Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports * Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes * Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making * Support Financial Analysis projects related to medical cost reduction initiatives and budgeting same * Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results * Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare JOB QUALIFICATIONS Required Education Bachelor's Degree in Finance, Economics, Math, Healthcare Management, Computer Science, Information Systems, or related field Required Experience * 3 years management or team leadership experience * 10 years analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) * Strong Knowledge of SQL and PowerBI report development * Familiar with relational database concepts, and SDLC concepts Preferred Education Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field. Preferred Experience * 3 - 5 years supervisory experience * Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans * Experience with Databricks * Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.) * Proficiency with Excel and SQL for retrieving specified information from data sources. * Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form) * Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. • Understanding of value-based risk arrangements * Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare * To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $88,453 - $206,981 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The Manager, Medical Economics provides support and consultation to the New York Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives improvement change by recommending actionable initiatives to C-level Suite executives to mitigate these trends. Responsible for conducting complex analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities. KNOWLEDGE/SKILLS/ABILITIES Manages and provides direct oversight of Medical Economics Team activities and personnel. Provides technical expertise, manages relationships with operational leaders and staff. Directs staff assigned to their projects, supports health plan market(s) with trend analyses, finding scoreable action items (SAIs) and ad hoc analyses as requested. Responsible for staff time keeping, performance coaching, development, and career paths. * Extract and compile information from various systems to support executive decision-making * Mine and manage information from large data sources. * Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs. * Work with clinical, provider network and other personnel to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions. * Work with business owners to track key performance indicators of medical interventions * Perform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives * Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action plan * Draw actionable conclusions based on analyses performed, make recommendations through use of healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterprise * Analyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management * Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports * Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes * Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making * Support Financial Analysis projects related to medical cost reduction initiatives and budgeting same * Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results * Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare JOB QUALIFICATIONS Required Education Bachelor's Degree in Finance, Economics, Math, Healthcare Management, Computer Science, Information Systems, or related field Required Experience * 3 years management or team leadership experience * 10 years analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) * Strong Knowledge of SQL and PowerBI report development * Familiar with relational database concepts, and SDLC concepts Preferred Education Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field. Preferred Experience * 3 - 5 years supervisory experience * Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans * Experience with Databricks * Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.) * Proficiency with Excel and SQL for retrieving specified information from data sources. * Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form) * Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. • Understanding of value-based risk arrangements * Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare * To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $88,453 - $206,981 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The Manager, Medical Economics provides support and consultation to the New York Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives improvement change by recommending actionable initiatives to C-level Suite executives to mitigate these trends. Responsible for conducting complex analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities. KNOWLEDGE/SKILLS/ABILITIES Manages and provides direct oversight of Medical Economics Team activities and personnel. Provides technical expertise, manages relationships with operational leaders and staff. Directs staff assigned to their projects, supports health plan market(s) with trend analyses, finding scoreable action items (SAIs) and ad hoc analyses as requested. Responsible for staff time keeping, performance coaching, development, and career paths. * Extract and compile information from various systems to support executive decision-making * Mine and manage information from large data sources. * Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs. * Work with clinical, provider network and other personnel to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions. * Work with business owners to track key performance indicators of medical interventions * Perform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives * Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action plan * Draw actionable conclusions based on analyses performed, make recommendations through use of healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterprise * Analyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management * Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports * Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes * Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making * Support Financial Analysis projects related to medical cost reduction initiatives and budgeting same * Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results * Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare JOB QUALIFICATIONS Required Education Bachelor's Degree in Finance, Economics, Math, Healthcare Management, Computer Science, Information Systems, or related field Required Experience * 3 years management or team leadership experience * 10 years analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) * Strong Knowledge of SQL and PowerBI report development * Familiar with relational database concepts, and SDLC concepts Preferred Education Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field. Preferred Experience * 3 - 5 years supervisory experience * Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans * Experience with Databricks * Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.) * Proficiency with Excel and SQL for retrieving specified information from data sources. * Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form) * Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. • Understanding of value-based risk arrangements * Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare * To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $88,453 - $206,981 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The Manager, Medical Economics provides support and consultation to the New York Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives improvement change by recommending actionable initiatives to C-level Suite executives to mitigate these trends. Responsible for conducting complex analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities. KNOWLEDGE/SKILLS/ABILITIES Manages and provides direct oversight of Medical Economics Team activities and personnel. Provides technical expertise, manages relationships with operational leaders and staff. Directs staff assigned to their projects, supports health plan market(s) with trend analyses, finding scoreable action items (SAIs) and ad hoc analyses as requested. Responsible for staff time keeping, performance coaching, development, and career paths. * Extract and compile information from various systems to support executive decision-making * Mine and manage information from large data sources. * Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs. * Work with clinical, provider network and other personnel to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions. * Work with business owners to track key performance indicators of medical interventions * Perform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives * Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action plan * Draw actionable conclusions based on analyses performed, make recommendations through use of healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterprise * Analyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management * Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports * Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes * Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making * Support Financial Analysis projects related to medical cost reduction initiatives and budgeting same * Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results * Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare JOB QUALIFICATIONS Required Education Bachelor's Degree in Finance, Economics, Math, Healthcare Management, Computer Science, Information Systems, or related field Required Experience * 3 years management or team leadership experience * 10 years analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) * Strong Knowledge of SQL and PowerBI report development * Familiar with relational database concepts, and SDLC concepts Preferred Education Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field. Preferred Experience * 3 - 5 years supervisory experience * Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans * Experience with Databricks * Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.) * Proficiency with Excel and SQL for retrieving specified information from data sources. * Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form) * Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. • Understanding of value-based risk arrangements * Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare * To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $88,453 - $206,981 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The Manager, Medical Economics provides support and consultation to the New York Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives improvement change by recommending actionable initiatives to C-level Suite executives to mitigate these trends. Responsible for conducting complex analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities. KNOWLEDGE/SKILLS/ABILITIES Manages and provides direct oversight of Medical Economics Team activities and personnel. Provides technical expertise, manages relationships with operational leaders and staff. Directs staff assigned to their projects, supports health plan market(s) with trend analyses, finding scoreable action items (SAIs) and ad hoc analyses as requested. Responsible for staff time keeping, performance coaching, development, and career paths. * Extract and compile information from various systems to support executive decision-making * Mine and manage information from large data sources. * Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs. * Work with clinical, provider network and other personnel to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions. * Work with business owners to track key performance indicators of medical interventions * Perform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives * Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action plan * Draw actionable conclusions based on analyses performed, make recommendations through use of healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterprise * Analyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management * Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports * Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes * Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making * Support Financial Analysis projects related to medical cost reduction initiatives and budgeting same * Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results * Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare JOB QUALIFICATIONS Required Education Bachelor's Degree in Finance, Economics, Math, Healthcare Management, Computer Science, Information Systems, or related field Required Experience * 3 years management or team leadership experience * 10 years analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) * Strong Knowledge of SQL and PowerBI report development * Familiar with relational database concepts, and SDLC concepts Preferred Education Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field. Preferred Experience * 3 - 5 years supervisory experience * Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans * Experience with Databricks * Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.) * Proficiency with Excel and SQL for retrieving specified information from data sources. * Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form) * Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. • Understanding of value-based risk arrangements * Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare * To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $88,453 - $206,981 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Molina Healthcare Services (HCS) works with 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. **Positions available in NE Ohio: Cuyahoga, Geauga, Lake, Lorain, Medina and Cleveland** **KNOWLEDGE/SKILLS/ABILITIES** + Completes face-to-face comprehensive assessments of members per regulated timelines. + Facilitates comprehensive waiver enrollment and disenrollment processes. + Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals. + Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. + Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members. + Assesses for medical necessity and authorize all appropriate waiver services. + Evaluates covered benefits and advise appropriately regarding funding source. + Conducts face-to-face or home visits as required. + Facilitates interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration. + Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. + Assesses for barriers to care, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns. + Identifies critical incidents and develops prevention plans to assure member's health and welfare. + Provides consultation, recommendations and education as appropriate to non-RN case managers + Works cases with members who have complex medical conditions and medication regimens + Conducts medication reconciliation when needed. + 50-75% travel required. **JOB QUALIFICATIONS** **Required Education** Graduate from an Accredited School of Nursing **Required Experience** + At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports. + 1-3 years in case management, disease management, managed care or medical or behavioral health settings. + Required License, Certification, Association + Active, unrestricted State Registered Nursing license (RN) in good standing + If field work is required, Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation. **Preferred Education** Bachelor's Degree in Nursing **Preferred Experience** + 3-5 years in case management, disease management, managed care or medical or behavioral health settings. + 1 year experience working with population who receive waiver services. **Preferred License, Certification, Association** Active and unrestricted Certified Case Manager (CCM) To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. \#PJHS3 Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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, including in-person home visits as required. * Facilitates comprehensive waiver enrollment and disenrollment processes. * Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. * Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. * Assesses for medical necessity and authorizes all appropriate waiver services. * Evaluates covered benefits and advises appropriately regarding funding sources. * Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. * Identifies critical incidents and develops prevention plans to assure member health and welfare. * May provide consultation, resources and recommendations to peers as needed. * Care manager RNs may be assigned complex member cases and medication regimens. * Care manager RNs may conduct medication reconciliation as needed. * 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications * At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice. * Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. * Ability to operate proactively and demonstrate detail-oriented work. * Demonstrated knowledge of community resources. * Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. * Ability to work independently, with minimal supervision and demonstrate self-motivation. * Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. * Ability to develop and maintain professional relationships. * Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. * Excellent problem-solving and critical-thinking skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. * In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications * Certified Case Manager (CCM). * Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $23.76 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The Revenue Cycle Clinician for the Appellate Solution is responsible for: * Recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review * Preparing and documenting appeal based on industry accepted criteria. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. 1. Performs retrospective (post -discharge/ post-service) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review. 2. Demonstrates proficiency in use of medical necessity criteria sets, currently InterQual or other key factors or systems as evidenced by Inter-rater reliability studies and other QA audits. Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate module of InterQual criteria (Acute, Procedures, etc). If clinical review does not meet IQ criteria, other pertinent clinical facts are utilized to support the appeal. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization. 3. Demonstrates ability to critically think and follow documented processes for supporting the clinical appellate process. 4. Adhers to the department standards for productivity and quality goals. Ensuring accounts assigned are worked in a timely manner based on the payor guidelines. 5. Demonstrates proficiency in utilization of electronic tools including but not limited to ACE, nThrive, eCARE, Authorization log, InterQual, VI, HPF, as well as competency in Microsoft Office. 6.Demonstrates basic patient accounting knowledge i.e. UB92/UB04 and EOB components, adjustments, credits, debits, balance due, patient liability, denials management, etc. 7. Additional responsibilities: a) Serves as a resource to non-clinical personnel. b) Provides CRC leadership with sound solutions related to process improvement c) Assist in development of policy and procedures as business needs dictate. d) Assists Law Department with any medical necessity reviews as capacity allows up to and including attending mediation hearings, other litigation forums, etc. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Demonstrates proficiency in the application of medical necessity criteria, currently InterQual * Possesses excellent written, verbal and professional letter writing skills * Critical thinker, able to make decisions regarding medical necessity independently * Ability to interact intelligently and professionally with other clinical and non-clinical partners * Demonstrates knowledge of managed care contracts including reimbursement matrixes and terms * Ability to multi-task * Ability to conduct research regarding State/Federal appellate guidelines and applicable regulatory processes related to the appellate process. * Ability to conduct research regarding off-label use of medications Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * Must possess a valid nursing license (Registered) * Minimum of 3 yearsacute care experience in a facility environment * Medical-surgical/critical care experience preferred * Appeals writing experience preffered * Minimum of 2 years UR/Case Management experience preferred * Managed care payor experience a plus either in Utilization Review, Case Management or Appeals * * Previous classroom led instruction on InterQual or MCG products (Acute Adult, Peds, Outpatient and Behavioral Health) preferred CERTIFICATES, LICENSES, REGISTRATIONS * Current, valid RN/ licensure * Certified Case Manager (CCM) or Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR , CPUM, or CPHM) preferred PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to lift 15-20lbs * Ability to travel approximately 10% of the time; either to facility sites, National Insurance Center (NIC) sites, Headquarters or other designated sites * Ability to sit and work at a computer for a prolonged period of time conducting medical necessity reviews WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc. OTHER * May require travel - approximately 10% * Interaction with facility Case Management, Physician Advisor is a requirement. Compensation and Benefit Information Compensation * Pay: $30.85 - $46.28 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. 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. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays 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, including in-person home visits as required. * Facilitates comprehensive waiver enrollment and disenrollment processes. * Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. * Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. * Assesses for medical necessity and authorizes all appropriate waiver services. * Evaluates covered benefits and advises appropriately regarding funding sources. * Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. * Identifies critical incidents and develops prevention plans to assure member health and welfare. * May provide consultation, resources and recommendations to peers as needed. * Care manager RNs may be assigned complex member cases and medication regimens. * Care manager RNs may conduct medication reconciliation as needed. * 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications * At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice. * Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. * Ability to operate proactively and demonstrate detail-oriented work. * Demonstrated knowledge of community resources. * Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. * Ability to work independently, with minimal supervision and demonstrate self-motivation. * Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. * Ability to develop and maintain professional relationships. * Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. * Excellent problem-solving and critical-thinking skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. * In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications * Certified Case Manager (CCM). * Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. 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. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays 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, including in-person home visits as required. - Facilitates comprehensive waiver enrollment and disenrollment processes. - Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. - Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. - Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. - Assesses for medical necessity and authorizes all appropriate waiver services. - Evaluates covered benefits and advises appropriately regarding funding sources. - Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. - Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. - Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. - Identifies critical incidents and develops prevention plans to assure member health and welfare. - May provide consultation, resources and recommendations to peers as needed. - Care manager RNs may be assigned complex member cases and medication regimens. - Care manager RNs may conduct medication reconciliation as needed. - 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications - At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. - Ability to operate proactively and demonstrate detail-oriented work. - Demonstrated knowledge of community resources. - Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. - Ability to work independently, with minimal supervision and demonstrate self-motivation. - Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. - Ability to develop and maintain professional relationships. - Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. - Excellent problem-solving and critical-thinking skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. - In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications - Certified Case Manager (CCM). - Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. 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. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays 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, including in-person home visits as required. * Facilitates comprehensive waiver enrollment and disenrollment processes. * Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. * Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. * Assesses for medical necessity and authorizes all appropriate waiver services. * Evaluates covered benefits and advises appropriately regarding funding sources. * Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. * Identifies critical incidents and develops prevention plans to assure member health and welfare. * May provide consultation, resources and recommendations to peers as needed. * Care manager RNs may be assigned complex member cases and medication regimens. * Care manager RNs may conduct medication reconciliation as needed. * 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications * At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice. * Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. * Ability to operate proactively and demonstrate detail-oriented work. * Demonstrated knowledge of community resources. * Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. * Ability to work independently, with minimal supervision and demonstrate self-motivation. * Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. * Ability to develop and maintain professional relationships. * Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. * Excellent problem-solving and critical-thinking skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. * In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications * Certified Case Manager (CCM). * Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. 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. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays 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, including in-person home visits as required. - Facilitates comprehensive waiver enrollment and disenrollment processes. - Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. - Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. - Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. - Assesses for medical necessity and authorizes all appropriate waiver services. - Evaluates covered benefits and advises appropriately regarding funding sources. - Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. - Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. - Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. - Identifies critical incidents and develops prevention plans to assure member health and welfare. - May provide consultation, resources and recommendations to peers as needed. - Care manager RNs may be assigned complex member cases and medication regimens. - Care manager RNs may conduct medication reconciliation as needed. - 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications - At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. - Ability to operate proactively and demonstrate detail-oriented work. - Demonstrated knowledge of community resources. - Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. - Ability to work independently, with minimal supervision and demonstrate self-motivation. - Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. - Ability to develop and maintain professional relationships. - Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. - Excellent problem-solving and critical-thinking skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. - In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications - Certified Case Manager (CCM). - Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

*** Offering up to a $20,000 Sign-On for eligible Full Time, Registered Nurse candidates! *** Why MountainView Regional Medical Center? We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. Team members across our organization enjoy working in team environments and making a difference in the health and well-being of the patients they serve. Their efforts are rewarded through numerous recognition programs and our affiliates also offer team member benefits, including: Competitive compensation Paid time off plans for vacations, holidays and illness Health insurance, including coverage for medical, dental, vision and prescription drugs 401(k) retirement plan Education & student loan assistance Life and disability insurance Flexible spending accounts About Who We Are We are a 168-bed Joint Commission accredited acute care facility serving Las Cruces and southern New Mexico. A legacy of rich history, culture and natural beauty; Las Cruces remains one of the Southwest's best kept secrets. With a thriving arts scene, a focus on downtown, adjacent national monuments and plenty of Southwest charm, there's always something for you and your family to do or see in Las Cruces. Often recognized nationally as a top place to live and retire, Las Cruces offers a welcoming community. MountainView Regional Medical Center is Las Cruces Strong! Start your new job search here and see why we are ….Proud to be MountainView! Job Summary The Care Manager - RN is responsible for coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves collaborating with interdisciplinary teams, reviewing medical records for appropriateness and medical necessity, and maintaining compliance with federal, state, and accreditation standards. Essential Functions Conducts daily reviews of medical records to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services. Collaborates with interdisciplinary teams (IDT) to ensure effective communication and coordination of patient care, including identifying avoidable days and resolving care transition issues. Develops and implements discharge plans, coordinating post-hospital placement and social services to meet patient needs. Refers cases to physicians or managers when patients do not meet established criteria, ensuring timely and appropriate interventions. Serves as a liaison with community agencies, maintaining relationships and facilitating seamless transitions for discharged patients. Facilitates interdisciplinary meetings to address patient care needs, resolve challenges, and support collaborative care planning. Maintains accurate and timely documentation of case management activities, including records of referrals, patient interactions, and compliance with reporting requirements. Identifies and appropriately refers cases to Child/Adult Protective Services, ensuring compliance with legal and ethical standards. Provides professional assistance to patients, families, and physicians regarding discharge planning and post-hospital care options. Performs other duties as assigned. Complies with all policies and standards. Qualifications Bachelor's Degree in Nursing preferred 2-4 years of clinical nursing experience in a hospital, home health, or nursing home setting required 2-4 years of care management experience preferred Knowledge, Skills and Abilities Strong understanding of case management principles, discharge planning, and transitions of care. Knowledge of federal, state, and Joint Commission standards related to case management. Excellent communication and interpersonal skills to collaborate effectively with patients, families, and interdisciplinary teams. Ability to assess complex situations, identify solutions, and implement care plans efficiently. Proficiency in electronic medical records (EMR) and documentation systems. Strong organizational and time management skills to prioritize tasks in a dynamic environment. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure required BCLS - Basic Life Support required State Specific Requirements Alabama: Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification preferred. New Mexico: Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) certifications preferred.

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. 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. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays 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, including in-person home visits as required. * Facilitates comprehensive waiver enrollment and disenrollment processes. * Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. * Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. * Assesses for medical necessity and authorizes all appropriate waiver services. * Evaluates covered benefits and advises appropriately regarding funding sources. * Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. * Identifies critical incidents and develops prevention plans to assure member health and welfare. * May provide consultation, resources and recommendations to peers as needed. * Care manager RNs may be assigned complex member cases and medication regimens. * Care manager RNs may conduct medication reconciliation as needed. * 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications * At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice. * Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. * Ability to operate proactively and demonstrate detail-oriented work. * Demonstrated knowledge of community resources. * Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. * Ability to work independently, with minimal supervision and demonstrate self-motivation. * Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. * Ability to develop and maintain professional relationships. * Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. * Excellent problem-solving and critical-thinking skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. * In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications * Certified Case Manager (CCM). * Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. 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. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays 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, including in-person home visits as required. - Facilitates comprehensive waiver enrollment and disenrollment processes. - Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. - Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. - Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. - Assesses for medical necessity and authorizes all appropriate waiver services. - Evaluates covered benefits and advises appropriately regarding funding sources. - Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. - Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. - Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. - Identifies critical incidents and develops prevention plans to assure member health and welfare. - May provide consultation, resources and recommendations to peers as needed. - Care manager RNs may be assigned complex member cases and medication regimens. - Care manager RNs may conduct medication reconciliation as needed. - 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications - At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. - Ability to operate proactively and demonstrate detail-oriented work. - Demonstrated knowledge of community resources. - Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. - Ability to work independently, with minimal supervision and demonstrate self-motivation. - Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. - Ability to develop and maintain professional relationships. - Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. - Excellent problem-solving and critical-thinking skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. - In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications - Certified Case Manager (CCM). - Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. 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. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays 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, including in-person home visits as required. * Facilitates comprehensive waiver enrollment and disenrollment processes. * Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. * Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. * Assesses for medical necessity and authorizes all appropriate waiver services. * Evaluates covered benefits and advises appropriately regarding funding sources. * Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. * Identifies critical incidents and develops prevention plans to assure member health and welfare. * May provide consultation, resources and recommendations to peers as needed. * Care manager RNs may be assigned complex member cases and medication regimens. * Care manager RNs may conduct medication reconciliation as needed. * 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications * At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice. * Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. * Ability to operate proactively and demonstrate detail-oriented work. * Demonstrated knowledge of community resources. * Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. * Ability to work independently, with minimal supervision and demonstrate self-motivation. * Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. * Ability to develop and maintain professional relationships. * Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. * Excellent problem-solving and critical-thinking skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. * In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications * Certified Case Manager (CCM). * Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. 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. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays 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, including in-person home visits as required. - Facilitates comprehensive waiver enrollment and disenrollment processes. - Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. - Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. - Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. - Assesses for medical necessity and authorizes all appropriate waiver services. - Evaluates covered benefits and advises appropriately regarding funding sources. - Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. - Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. - Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. - Identifies critical incidents and develops prevention plans to assure member health and welfare. - May provide consultation, resources and recommendations to peers as needed. - Care manager RNs may be assigned complex member cases and medication regimens. - Care manager RNs may conduct medication reconciliation as needed. - 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications - At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. - Ability to operate proactively and demonstrate detail-oriented work. - Demonstrated knowledge of community resources. - Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. - Ability to work independently, with minimal supervision and demonstrate self-motivation. - Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. - Ability to develop and maintain professional relationships. - Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. - Excellent problem-solving and critical-thinking skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. - In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications - Certified Case Manager (CCM). - Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.