Molina Healthcare Jobs

- 3,101 Jobs

  • Specialist, Quality Interventions/QI Compliance Iowa - Remote

    KNOWLEDGE/SKILLS/ABILITIES The Specialist, Quality Interventions/ QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.
    $30k-36k yearly est.1d ago

  • Supervisor, Member Services (Remote - Candidate must reside in the State of Iowa)

    Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information and identifies opportunities to improve our member and provider experiences. KNOWLEDGE/SKILLS/ABILITIES Supervises a team of employees. Trains, coaches, monitors, and manages the team's performance to meet or exceed company and department performance expectations. Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure. Ensures compliance with Contractual and Regulatory requirements. Addresses more complex member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Provides exemplary customer service to customers including members, co-workers, vendors, providers, government agencies, business partners, and general public. Achieves individual performance goals as it relates to call center objectives. Demonstrates personal responsibility and accountability and leads by example through individual performance. Support projects and special initiatives as appropriate. JOB QUALIFICATIONS Required Education Associate degree or equivalent combination of education and experience Required Experience 3-5 years' experience in a call center environment 1-2 years supervisory experience Preferred Education Bachelor's Degree or equivalent combination of education and experience Preferred Experience 5-7 years 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: $41,264 - $80,465 a year* *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $41.3k-80.5k yearly1d ago

  • Manager, Provider Quality & Practice Transformation (Remote IA)

    Responsible for continuous quality improvements and risk adjustment accuracy for all government lines of business. Supports robust provider engagement to achieve positive operational and financial outcomes. KNOWLEDGE/SKILLS/ABILITIES Establishes the strategy and operational direction for provider engagement and practice transformation, in collaboration with the Plan President, network and operations staff for larger value based contracted provider organizations. Provides strategic direction for provider quality and practice transformation specialists to help providers understand how to improve quality and progression toward meeting value-based purchasing goals and assesses provider readiness for higher levels on the value-based purchasing continuum. Ensures health plan provider engagement stakeholders are engaged and prepared to report quarterly updates at the meetings and overall, to health plan Senior Leadership Team meetings. Leads one or more teams from multiple disciplines (Quality, Provider Services, Clinical, Operations) to engage with key providers. Participates in state level quality and risk adjustment strategy meetings, develops a quality workplan, and ensures integration of quality and risk adjustment into the overall business process. Has overall responsibility for the content, maintenance and access to the Health Plan provider quality and practice transformation SharePoint site. Builds internal relationships to develop a team approach to provider engagement. Builds and nurture positive relationships between strategic providers and Plan. Reports on strategic provider results (e.g., changes in quality outcomes, financial results, etc.) on periodic basis to Senior Leadership Team. JOB QUALIFICATIONS Required Education: Bachelor's Degree or equivalent combination of education and experience. Required Experience: Min 5 years' experience in managed healthcare administration and/or Provider Services. Provider contract network development & management experience Project management experience, in a managed healthcare setting Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid, Marketplace and Medicare lines of business, including but not limited to fee-for service, capitation and various forms of risk, ASO, etc. Preferred Education: Master's Degree Preferred Experience: Experience with risk adjustment and quality metrics with government business lines of business. Previous provider relationship and engagement preferred Experience with Value Based Contract arrangements, and provider engagement Preferred License, Certification, Association: RN license 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: $66,456.22 - $129,589.63 a year* *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. #PJAF #LI-Remote
    $33k-56k yearly est.1d ago

  • UM Nurse (remote must reside in Iowa)

    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. Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members.
    $26.4-51.5 hourly22d ago

  • Sr Specialist, Member Engagement - IA ONLY - REMOTE

    Participates in the Statewide Advocacy Program for Managed Care including working with the State External Advocate, Enrollment Specialist and Ombudsmen on issues of access to medical care, quality of care, enrollment and disenrollment.
    $35.5k-73.2k yearly1d ago

  • Lead, Customer Experience (Remote - Candidate must reside in the State of Iowa)

    Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Lead by the Molina Values Provides customer support and stellar service to meet the needs of our Molina members and providers.
    $16.4-32 hourly1d ago

  • Case Manager Remote in Iowa (Relocation Assistance Available)

    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. Local travel of up to 40% may be required, depending on the complexity level of the assigned members, particular state-specific regulations, or whether the Case Manager position is located within Molina's Central Programs unit. Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Case Manager (CCM), Certified in Health Education and Promotion (CHEP), Licensed Professional Counselor (LPC/LPCC), Respiratory Therapist, or Licensed Marriage and Family Therapist (LMFT).
    $33k-42k yearly est.1d ago

  • Analyst, Quality Interventions/QI Compliance Iowa - Remote

    Writes, prepares, and / or presents reports and analyses to evaluate performance improvement using a variety of sources, including, but not limited to: internal quantitative data; external industry data; survey data; input from members, providers and / or other key stakeholders; input from Molina employees and senior leaders, etc. Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. To all current Molina employees: If you are interes KNOWLEDGE/SKILLS/ABILITIES The Analyst, Quality Improvement (QI) Interventions/Compliance contributes to either or both of these critical Quality functions: Clinical Quality Interventions and Quality Improvement Compliance. Collaborates with other Quality Improvement staff to analyze and reports the results of quality improvement studies, initiatives and / or projects to monitor, evaluate and / or continuously improve the quality of healthcare services provided to Molina members.
    $49.9k-97.4k yearly1d ago

  • RN / Registered Nurse / Virginia / Permanent / Nurse Technician III - Surgery Job

    , a 199-bed acute facility, lies within the vibrant Town Center of Reston, known for its lively mix of restaurants, shops, and services. We are currently looking for an ambitious Nurse Technician III to help us reach our goals. Reston Hospital Center is an HCA (Hospital Corporation of America) facility making it a very secure and reputable facility to work with. Reston Hospital Center Most importantly, Reston Hospital Center is dedicated to enhancing the health and quality of life in our community by putting patients first.
    $28k-34k yearly est.7d ago

  • Histology Technician

    Come join our team as a(an) Histology Technician. HCA Healthcare Laboratory Services is opening a brand new state-of-the-art Central Laboratory to support Histology and Microbiology specialized testing for our HCA Healthcare hospitals in the Capital Division. Benefits HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. Just last year, HCA Healthcare and our colleagues donated $13.8 million dollars to charitable organizations.
    $56k-75k yearly est.3d ago

  • PRN Physical Therapist Home Health

    At HCA Virginia Healthcare at Home, you come first. Introduction Do you want to join an organization that invests in you as a PRN Physical Therapist Home Health? We are looking for a dedicated PRN Physical Therapist Home Health like you to be a part of our team. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. Benefits HCA Virginia Healthcare at Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. Employee Stock Purchase Plan with 10% off HCA Healthcare stock
    $75k-88k yearly est.5d ago

  • Medical Director (REMOTE in Iowa)

    Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality improvement staff. 2 years previous experience as a Medical Director in a clinical practice.
    $161.9k-315.7k yearly1d ago

  • Coding Educator - PA, NJ, DC, DE or MD

    Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Responsibilities The Coding Educator for the North East region reviews medical records and arranges educational sessions with providers aimed at quality of care and documentation improvements. Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. The Coding Educator identifies opportunities for the North East region to improve provider documentation and creates an education plan tailored to each assigned provider. In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits
    $50k-63k yearly est.11d ago

  • Sr. Specialist, Quality Interventions/QI Compliance - Remote in Iowa

    $24-46.8 hourly1d ago

  • Network Optimization Lead

    Knowledge of Humana's internal policies, procedures and systems. This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits. Humana Healthy Horizons is seeking a Network Optimization Lead, Ohio Medicaid, that is responsible for driving network optimization and value, while also managing compliance with network requirements, including network adequacy, in the Ohio Department of Medicaid Managed Care Contract.
    $55k-65k yearly est.3d ago

  • ETL Developer & Python Automation

    Health Quality Reporting and Improvement - Technology and Analytics (HTA) is an analytics organization that provides operational support for Humana's Medicare Risk Adjustment activities. Humana's health products and services are designed to encourage personal wellness and smart healthcare decisions for you and your family: Medical, dental, and vision benefits, Health plan incentives, Paternity leave, etc. Humana knows your life extends outside of work. Humana provides growth and career opportunities that can help you develop your skills and build your future with the organization: Internal and external learning events, Tuition assistance, Inclusion and diversity training, etc. You'll experience the following perks as a full-time Humana employee: This takes the form of data management, analytics, and reporting to provide timely, accurate, and actionable information for and about Humana's members and providers.
    $84k-102k yearly est.6d ago

  • Pharmacy Technician - Clinical Services (MTM) - Bilingual Spanish

    Centene is transforming the health of our communities, one person at a time. Licenses and Certifications: A license in one of the following is required: Certified Pharmacy Technician (CPhT) Preferred Highly preferred: Call center or experience with heavy call volume, Pharmacy Technician and/or medical field knowledge of prescription drugs (uses and doses).
    $29k-33k yearly est.26d ago

  • Lead, Customer Experience (Remote - Candidate must reside in the State of Iowa)

    Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Lead by the Molina Values Provides customer support and stellar service to meet the needs of our Molina members and providers.
    $16.4-32 hourly1d ago

  • Supervisor, Member Services - Ideal candidate will have Claims experience (Remote in Iowa)

    $41.3k-80.5k yearly1d ago

  • Supervisor, Member Services (Remote - Candidate must reside in the State of Iowa)

    $41.3k-80.5k yearly1d ago

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Updated March 31, 2023

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