Molina Healthcare jobs in Albuquerque, NM - 203 jobs

JOB DESCRIPTIONJob Summary Designs and implements processes and solutions associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and unstructured data from multiple disparate sources. Collaborates across departments and with customers to define requirements and understand business problems. Uses advanced mathematical, statistical, querying, and reporting methods to develop solutions. Develops information tools, algorithms, dashboards, and queries to monitor and improve business performance. Creates solutions from initial concept to fully tested production, and communicates results to a broad range of audiences. Effectively uses current and emerging technologies. KNOWLEDGE/SKILLS/ABILITIES * Extracts and compiles various sources of information and large data sets from various systems to identify and analyze outliers. * Sets up process for monitoring, tracking, and trending department data. * Prepares any state mandated reports and analysis. * Works with internal, external and enterprise clients as needed to research, develop, and document new standard reports or processes. * Implements and uses the analytics software and systems to support the departments goals. JOB QUALIFICATIONS Required Education Associate's Degree or equivalent combination of education and experience Required Experience 1-3 years Preferred Education Bachelor's Degree or equivalent combination of education and experience Preferred Experience 3-5 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: $80,168 - $116,835 / 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.

A Partnership Liaison is responsible for physician and practice outreach for internal physicians. In accordance with enterprise and local strategic priorities, this role will establish and foster relationships with physicians, practice managers and / or schedulers that best grow and develop USPI centers potential case volume and service lines. With the objective of increasing the selection of our centers by proceduralists, this role is primarily responsible for supporting credentialing and onboarding, facilitating increased access to procedural times, supporting service line expansion initiatives. All provider engagement, and work, to be done in accordance with the Company's Standards of Conduct and policies and procedures, particularly those involving referral source arrangements. PRIMARY JOB DUTIES AND RESPONSIBILITIES Responsible for planning and conducting in-person visits, predominantly focused on key stakeholders at proceduralist physician offices to increase selection of centers to perform cases at. This role will receive ongoing guidance from Business Development leadership on providers of focus and productivity expectations. Identify trends in assigned providers' utilization of the USPI center and facilitate discussions with the provider / practice to understand underlying dynamics, decision making behind facility selection, feedback etc. Coordinate with Operations team and provider / practice to optimize use of existing block times and increase the provider's access to procedural time at the center Conduct face-to-face sales meetings with clients ensuring through understanding of the center's attributes, specialty capabilities, processes as well as patient experience & safety outcomes Complete follow-up meetings with physicians, practice managers etc. to ensure thorough understanding of the physicians' desires, needs and obstacles to growth to increase potential case volumes at USPI centers Communicate feedback from clients and partner with the appropriate facility resources to facilitate credentialing and onboarding of new physicians as well as resolve issues such that providers practice more at USPI centers Prepare and present sales reports, measuring case volume growth, identifying trends, lessons learned, opportunities and areas for improvement to achieve facility and / or market goals. Continuously modify and execute business development tactics to ensure optimal business outcomes, based on feedback from providers and facility leaders. Maintain latest knowledge of the market hospital, ambulatory surgery and provider landscape, in your defined market service area. Document all client engagement in a timely manner on a daily basis in the defined CRM tool, including outcomes and required follow-up. Support the implementation of service line expansion, extended hours, case cancellation recapture and other relevant initiatives, as directed by the Business Development and Operations Leadership. Perform all duties with consistently high ethical standards and strict adherence to company policies and procedures. EDUCATION, EXPERIENCE, AND OTHER REQUIREMENTS Minimum Education High School diploma/GED required. Associate's degree preferred. Bachelor's degree strongly preferred. Minimum Experience At least 2-5 years of experience in a field related to health system physician relations, pharmaceuticals, or medical devices Other Requirements Exhibited success in a business development / sales role Possess and demonstrate excellent organizational, interpersonal, facilitation, and communication skills Capacity to work independently with minimal supervision Ability to travel in market. Selected candidate will be required to pass a Motor Vehicle Records check. #LI-SG2

The Strategy Advancement Director is responsible for advancing Molina's growth strategy and positioning the company for success in Medicaid, CHIP, DSNP, and Marketplace procurements. Reporting to the Vice President, Business Development, this position plays a pivotal role in the pre-RFP and procurement phases, guiding and organizing the project, ensuring deliverables are met, conducting research, tracking Business Development and/or Health Plan steps and projects, owning the governance structure for every opportunity, pulling together all the supporting team activities and pieces and connecting the dots between winning strategy and the relationships and partnerships developed by the VP, Business Development. This role requires a deep understanding of Medicaid programs, the regulatory environment, and the unique challenges of populations (i.e. TANF, ABD, DSNP, Foster Care, and DD/IDD). The Strategy Advancement Director works collaboratively across departments, including Product Development, Business Development, and Health Plans, to ensure that strategic initiatives align with state-specific priorities and are positioned for success in competitive procurements. The Director partners with the VP Market Development to provide thought leadership and subject matter expertise, identifying trends, providing insights, and continuously innovating to strengthen Molina's market position. **Job Duties** + Strategy Development & Innovation + Collaborate on the development of state-specific strategies aligned with state priorities, procurement objectives, and evolving Medicaid needs. Translate state regulatory requirements into actionable go-to-market strategies that are innovative and differentiate Molina in competitive procurements + Collaborate with Product Development, Health Plan leaders, Growth Leaders and cross-functional teams to support integration of innovative care models, operational efficiencies, and value-based care solutions tailored to the unique needs of market specific Medicaid populations, especially high-risk or vulnerable groups such as dual-eligible members, foster care, and ABD + Conduct market research, analyze industry trends, and monitor competitor activities to identify innovation opportunities. Propose solutions that address Medicaid ecosystem pain points and enhance Molina's value proposition + Use insights from market research and competitive analysis to stay informed on state Medicaid trends, regulatory changes, and market conditions, and to guide strategic adjustments and future market positioning + Drive the development of win themes and strategy recommendations that align with state priorities, competitive dynamics, and the latest Medicaid trends, positioning Molina as a leader in Medicaid managed care + Track regulatory compliance and address any operational concerns or state-specific issues identified during the pre-procurement phase. Escalate issues when necessary and work to resolve them proactively + Market Development and Strategy Execution + Collaborate on the development of pre-RFP strategy and market readiness, creating and tracking playbooks, plans, and deliverables for Molina's strategy two to three years before RFP release. Ensure alignment with organizational goals and state requirements by collaborating with Market VPs, AVPs, and stakeholders + Identify and engage in thought leadership opportunities by representing Molina at state and national Medicaid conferences, industry forums, and other key events that enhance Molina's brand and expertise in Medicaid care delivery + Stakeholder Engagement & Thought Leadership + Support and track the development of relationships with state agencies, legislative leaders, regulatory bodies, and community organizations to enhance Molina's reputation and strengthen partnerships that could influence procurement outcomes + Represent Molina in strategic discussions with external partners and internal leadership, ensuring clear communication of strategy, innovation, and value propositions + Collaborate with internal stakeholders to influence thought leadership materials and content that showcase Molina's innovative approaches to Medicaid, particularly in high-needs areas like DSNP, ABD, and complex populations + Proposal Support & Competitive Differentiation + Serve as an expert on the pre-procurement process for the proposal team and closely collaborate with the Proposal Director to ensure consistency between market strategy, capture strategy and proposal content. Collaborate with the Proposal Director to ensure consistency between market strategy and RFP content + Track and support the execution of win strategy and strategic recommendations being incorporated throughout the proposal, ensuring Molina's proposals are differentiated and align with state-specific priorities and the competitive landscape + Actively participate in blue, pink, and red team reviews, providing strategic feedback to ensure proposal materials effectively communicate Molina's competitive advantages and compliance with RFP requirements + Support orals preparation, working across matrix partners to refine materials and messaging for presentations to state agencies + Operational Excellence & Cross-Functional Coordination + Use tools (i.e. Salesforce) to document market intelligence, track engagement activities, and share insights across departments. Ensure that data-driven insights are leveraged in proposal content development and strategic planning + Collaborate with the Growth Strategy, Competitive Intelligence and other stakeholders to leverage the competitive intelligence repository that informs decision-making and provides a strategic edge in Medicaid procurements + Develop project plans and roadmaps to guide the timely execution of pre-RFP and procurement activities, ensuring effective collaboration and alignment across functional teams + Facilitate cross-functional coordination for market entry, retention, and development strategies, ensuring that all teams are aligned and executing efficiently + Supports the VP Business Development as a SME during the "warranty period" post award through implementation to the IMO and health plan leadership + Mentorship & Team Development + Mentor junior staff and interns within the Business Development teams, fostering skills in strategic thinking, market research, and pre-procurement planning + Participate in business development activities on an ad-hoc basis, contributing to team knowledge and providing strategic insights to senior leadership + 50% or more Travel required **Job Qualifications** **REQUIRED QUALIFICATIONS:** + Bachelor's degree in business, Public Policy, Healthcare Administration or a related field or equivalent combination of education and experience + 7 years in market strategy, business development, or healthcare consulting, specifically within Medicaid managed care or equivalent related field + Proven experience in pre-RFP strategy development, with a strong understanding of Medicaid programs, including TANF, ABD, DSNP, and CHIP populations + Demonstrated ability to drive innovative solutions in the Medicaid space, leveraging market research and industry trends to inform strategic decisions + Experience with Salesforce or similar tools to track market insights, engagement activities, and manage data + Strong experience in stakeholder engagement, particularly with state Medicaid agencies, regulatory bodies, and community-based organizations + Advanced proficiency in Microsoft Office tools (Excel, PowerPoint, Word), including for strategy development, data analysis, and presentation creation **PREFERRED QUALIFICATIONS:** + Master's degree (MBA, MPH, MPA) in business, public policy, or healthcare administration + 7+ years in business development and Medicaid procurements, particularly with complex populations (e.g., DD/IDD, Foster Care, Dual-Eligible Members) + Experience with Salesforce or similar tools to track market insights, engagement activities, and manage data + Conference management experience and participation in industry forums 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: $107,028 - $208,705 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Become a part of our caring community and help us put health first With over 10 million sales interactions annually, Humana understands that while great products are important, it's the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live in the designated territory to effectively serve their local community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll help bring Humana's strategy to life: Deliver on the fundamentals, differentiate through exceptional service, and grow by expanding our reach and impact. What You'll Do in This FIELD Based Role: * Deliver: Build trust and educate individuals on Humana's Medicare Advantage plans and additional offerings like Life, Dental, Vision, and Prescription coverage. * Differentiate: Create meaningful, face-to-face connections through grassroots marketing, community events, and in-home visits-providing a personalized experience that sets Humana apart. * Grow: Drive self-generated sales, meet performance goals, and expand Humana's presence in the market by becoming a valued resource in your community. You'll engage with customers in the FIELD through a mix of in-person, virtual, and phone interactions. Face-to-face visits in prospective members' homes are a key part of this role. Why Join Humana? * People-first culture that supports your personal and professional growth. * Inclusive and diverse environment that values multilingual talent and cultural understanding. * Autonomy and flexibility to manage your schedule and success. * Purpose-driven mission to help people achieve their best health-and transform healthcare along the way. Benefits include: * Medical, Dental, Vision, and a variety of other supplemental insurances * Paid Time Off (PTO) and Paid Holidays * 401(k) retirement savings plan with a competitive match * Tuition reimbursement and/or scholarships for qualifying dependent children * And much more! Use your skills to make an impact Required Qualifications * Active Health Insurance License or ability to obtain. * Must reside in the designated local territory to effectively serve the community. * Comfortable with daily face-to-face interactions in prospective members' homes and engaging with the community through service, organizations, volunteer work, or local events. * Valid state driver's license and proof of personal vehicle liability insurance meeting at least 25/25/10 coverage limits (or higher, based on state requirements). Preferred Qualifications * Active Life and Variable Annuity Insurance License. * Prior experience selling Medicare products. * Experience in public speaking or delivering presentations to groups. * Associate's or Bachelor's degree. * Experience using Microsoft Office tools such as Teams, Excel, Word, and PowerPoint. * Bilingual in English and Spanish, with the ability to speak, read, and write fluently in both languages. Additional Information * This position is in scope of Humana's Driving Safety and Vehicle Management Program and therefore subject to driver license validation and MVR review. * Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. * Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Schedule: Meeting with members requires appointments and/or event times that may vary on nights and weekends. Flexibility is essential to your success. Training: The first five weeks of employment and attendance is mandatory. Interview Format: As part of our hiring process for this opportunity, we are using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move forward in the process, you will receive a text message inviting you to participate in a HireVue prescreen. In this prescreen, you will receive a set of questions via text and given the opportunity to respond to each question. You should anticipate this prescreen taking about 15 minutes. Your responses will be reviewed and if selected to move forward, you will be contacted with additional details involving the next step in the process. Pay Range The range below reflects a good faith estimate of total compensation for full time (40 hours per week) employment at the time of posting. This compensation package includes both base pay and commission with guarantee. The pay range may be higher or lower based on geographic location. Actual earnings will vary based on individual performance, with the base salary and commission structure aligned to company policies and applicable pay transparency requirements. $80,000 - $125,000 per year #medicaresalesrep Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

is March 2026.** Leads and supervises team responsible for enterprise network management and operations activities including network development, network adequacy, and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. **JOB QUALIFICATIONS** **Job Duties:** - Oversees national Molina network management and operations function and team. Responsible for the daily operations of the department, including leading and supporting various enterprise-wide provider services activities including education, outreach and resolving provider inquiries. - Develops and deploys strategic network planning tools to drive provider services and contracting strategy across the enterprise. - Facilitates strategic planning and documentation of network management standards and processes. - Develops standards and resources to help Molina health plans successfully develop and refine cost-effective and high-quality strategic provider networks, establishing both internal and external long-term partnerships. - Collaborates with health plan network leadership and operations teams and functional business unit stakeholders to lead and/or support various provider services functions and strategic initiatives with an emphasis on developing and implementing standards, resources, tools and best practices sharing across the organization. - Develops and deploys strategic network planning tools to drive provider services and contracting strategies across the organization; facilitates planning and documentation of network management standards and processes for all line of business. - Oversees national network management and operations provider contracting strategies - identifying specialties and geographic locations to concentrate resources for purposes of establishing a sufficient network of participating providers to serve the health care needs of Molina members. - Oversees and leads the functions of the external provider representatives, including developing and/or presenting policies and procedures, training materials, and reports to meet internal/external standards. - Assists with ongoing enterprise-wide provider network development and the education of contracted network providers regarding various health plan procedures and claims payment policies. - Develops and implements tracking tools to ensure timely issue resolution and compliance with all network-related standards. - Oversees appropriate and timely intervention/communication when providers have issues or complaints (e.g. claims and encounter data, eligibility, reimbursement, and provider website). - Serves as a resource to support health plam initiatives and help ensure regulatory requirements and strategic goals are realized. - Ensures appropriate cross-departmental communication of provider network initiatives and contracted network provider issues. - Designs and implements enterprise-wide programs to build and nurture positive relationships between contracted providers, ancillary providers, hospital facilities and health plans. - Develops and implements enterprise-wide strategies to increase provider engagement in Healthcare Effectiveness Data Information Set (HEDIS) and quality initiatives. - Provides matrixed team support including: new markets provider/contract support services, resolution support, and national contract management support services. - Builds, drafts and/or performs provider communications, training and education programs for internal staff, external providers, and other stakeholders. - Develops and implements strategies to reduce member access grievances with contracted enterprise providers. - Engages enterprise-wide contracted network providers regarding cost-control initiatives, medical cost ratio (MCR), non-emergent utilization, and Consumer Assessment of Healthcare Providers and Systems (CAHPS) to positively influence future trends. - Ensures compliance with applicable company/plan business requirements including state/federal statutes, government sponsored program requirements, and network access standards. - Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration. **Job Requirements:** - At least 5 years of provider services experience, including experience supporting individual/group providers, hospitals, integrated delivery systems, and ancillary providers with Medicaid, Medicare, and or Marketplace products, or equivalent combination of relevant education and experience. - Understanding of the health care delivery system, including government-sponsored health plans. - Experience with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc. - Previous experience with community agencies and providers. - Organizational skills and attention to detail. - Ability to manage multiple tasks and deadlines effectively. - Interpersonal skills, including ability to interface with providers and medical office staff. - Experience with preparing and presenting formal presentations. - Project management experience. - Ability to work in a cross-functional highly matrixed organization. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. **Preferred Qualifications:** - Management/leadership experience. - Contract negotiation experience. 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: $80,168 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for coordination of benefits review activities that directly impact medical expenses and premium reimbursement. Responsible for primarily coordinating benefits with other carriers responsible for payment. Facilitates administrative support, data entry, and accurate maintenance of other insurance records. **Job Duties** + Provides telephone, administrative and data entry support for the coordination of benefits (COB) team. + Phones or utilizes other insurance company portals to validate state, vendor, and internal COB leads. + Updates the other insurance table on the claims transactional system and COB tracking database. + Review of claims identified for overpayment recovery. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + At least 1 year of administrative support experience, or equivalent combination of relevant education and experience. + Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. + Strong verbal and written communication skills. + Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders. + Microsoft Office suite proficiency. **PREFERRED QUALIFICATIONS:** + Health care experience 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: $21.65 - $31.71 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Become a part of our caring community and help us put health first As a therapist at CenterWell Home Health, you'll play a vital role in helping patients regain strength, mobility and independence-all from the comfort of their homes. By delivering personalized care that focuses on rehabilitation and functional improvement, you'll empower individuals to overcome physical limitations, perform everyday activities with confidence and enjoy a better quality of life. As a Home Health Physical Therapist, you will: * Plan and administer prescribed skilled physical therapy treatment and training for patients suffering from various injuries, illnesses and functional disabilities to attain highest level of physical function. * Test/screen the patient's physical strengths to assist the physician in evaluating the patient's level of function and records findings to develop or pursue treatment programs and establish measurable training objectives. * Develop/implement a conditioning/rehabilitation program consistent with physician's Plan of Treatment and the overall goals of the patient/rehab team. Adjust treatment as needed to achieve maximum results. * Confer with physician and clinical team members to obtain additional patient information and assist in developing, implementing and revising the therapy treatment program and Plan of Treatment. * Provide Physical Therapy Assistants and Home Health Aide staff with written instructions/care plan that reflects current plan of care as related to therapy, supervise/evaluate staffs' performance. Monitor the appropriate completion of documentation by physical therapy assistants and home health aides/personal care workers as part of the supervisory/leadership responsibility. * Accurately, promptly and thoroughly document patients' care observations, interventions and evaluations. Assure that interim (verbal) orders received from the physician and physical therapist are promptly and accurately documented, submitted for physician signature and implemented * Report patient's progress to the patient's physician, Clinical Manager, staff, patient and family. Submit evaluation, treatment plans, progress reports and discharge summary to the supervisor and care management staff. Use your skills to make an impact Required Experience/Skills: * Degree from an accredited Physical Therapy Program (approved by the APTA) * Minimum of one year physical therapy experience preferred * Current and unrestricted Physical Therapy license * Current CPR certification * Strong organizational and communication skills Pay Range * $54.00 - $76.00 - pay per visit/unit * $85,400 - $117,500 per year base pay Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $93,000 - $128,000 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Responsible for all information technology operations activities, including computer operations, data and operations support. Monitor budgets and expenses within department and accountable for meeting budget goals. Recommends input to policy principles and budget constraints. Provides expertise to departments regarding policies and procedures, problem resolution, and methods. **KNOWLEDGE/SKILLS/ABILITIES** + Analyzes, reviews and measures service level performance against agreed upon service level agreements (Service Level Agreements) with the business and operating-level agreements with service providers (internal and external). + Works closely with the business and service providers to negotiate and agree on service level requirements off any proposed new services and changes to existing services. + Works with the business and service providers to define the proper metrics and KPIs in evaluating service delivery quality and performance levels. Produces regular reports on service performance and achievement to stakeholders. + Organizes and maintains the service level review process with the business and service providers. Initiates any actions required to maintain or improve service levels. + Acts as a change agent to implement and manage quality improvement processes in service delivery management. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree or equivalent combination of education and experience **Required Experience** 5-7 years **Preferred Education** Graduate Degree or equivalent combination of education and experience **Preferred Experience** 7-9 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: $80,412 - $188,164 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties * Enters denials and requests for appeals into information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances. * Elevates appropriate appeals to the next level for review. * Generates and mails denial letters. * Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. Required Qualifications * At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. * Customer service experience. * Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. * Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). 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: $21.65 - $34.88 / 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.

JOB DESCRIPTION Job SummaryProvides support for medical records collection activities. Supports quality improvement activities through outreach to providers for collection of medical records for Healthcare Effectiveness Data and Information Set (HEDIS) specific data collection, projects and audit processes. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Outreaches to providers via phone call, fax, mail, electronic medical record system retrieval and direct on-site pick up for collection of medical records. * Loads medical records and reports from provider offices into the Healthcare Effectiveness Data and Information Set (HEDIS) application. * Supports annual HEDIS audit and other like audits, and organizes provider outreach, pursuit, collection and upload of provider medical records into the internal database. * Provides project management support to leadership via coordination, identification, pursuit and collection of medical records and other required data with other HEDIS staff. * Participates in meetings with vendors related to the medical record collection process. * Some medical records collection related travel may be required. Required Qualifications• At least 1 year customer service experience, preferably in an administrative support capacity in a health care setting, or equivalent combination of relevant education and experience. * Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements. * Excellent customer service and active listening skills. * Proficiency with data analysis tools (e.g., Excel). * Ability to manage files, schedules and information efficiently. * Ability to effectively interface with staff, clinicians, and leadership. * Strong prioritization skills and detail orientation. * Strong verbal and written communication skills, including professional phone etiquette. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Registered Health Information Technician (RHIT). * Medical records collection experience. * Managed care experience. * Basic knowledge of Healthcare Effectiveness Data Information Set (HEDIS) and National Committee for Quality Assurance (NCQA). * Project planning experience. 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: $21.65 - $31.71 / 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.

Become a part of our caring community and help us put health first Make a meaningful impact every day as a CenterWell Home Health nurse. You'll provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working closely with a dedicated team of physicians and clinicians, you'll develop and manage care plans that support recovery and help patients get back to the life they love. As a Home Health Registered Nurse, you will: * Provide admission, case management, and follow-up skilled nursing visits for home health patients. * Administer on-going care and case management for each patient, provide necessary follow-up as directed by the Clinical Manager. * Confer with physician in developing the initial plan of treatment based on physician's orders and initial patient assessment. Provide hands-on care, management and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision. Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation. * Coordinate appropriate care, encompassing various healthcare personnel (such as Physical Therapists, Occupational Therapists, Home Health Aides and external providers). * Report patient care/condition/progress to patient's physician and Clinical Manager on a continuous basis. * Implement patient care plan in conjunction with patient and family to assist them in achieving optimal resolution of needs/problems. * Coordinate/oversee/supervise the work of Home Health Aides, Certified Home Health Aides and Personal Care Workers and provides written personal care instructions/care plan that reflect current plan of care. Monitor the appropriate completion of documentation by home health aides/personal care workers as part of the supervisory/leadership responsibility. * Discharge patients after consultation with the physician and Clinical Manager, preparing and completing needed clinical documentation. * Prepare appropriate medical documentation on all patients, including any case conferences, patient contacts, medication order changes, re-certifications, progress updates, and care plan changes. Prepare visit/shift reports, updates/summarizes patient records, and confers with other health care disciplines in providing optimum patient care. Use your skills to make an impact Required Experience/Skills: * Diploma, Associate or Bachelor Degree in Nursing * Minimum of one year nursing experience preferred * Strong med surg, ICU, ER, acute experience * Home Health experience a plus * Current and unrestricted Registered Nurse licensure * Current CPR certification * Strong organizational and communication skills * Valid driver's license, auto insurance and reliable transportation Pay Range * $49.00 - $69.00 - pay per visit/unit * $77,600 - $106,600 per year base pay Scheduled Weekly Hours 1 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $77,200 - $106,200 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident. About Us About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

(Sales) Compliance Analyst Molina Healthcare's Medicare Compliance team supports sales operations for the Molina Medicare product lines. It is a centralized corporate function supporting compliance activities. KNOWLEDGE/SKILLS/ABILITIES is primarily responsible for Sales Oversight. * Provide regulatory expertise to the Sales Organization: both State and Federal * Have working knowledge of federal and state guidelines pertaining to Sales and Marketing. * Perform internal Sales/Marketing Compliance Reporting. * Perform internal Sales/Marketing monitoring. * Detailed oriented to conduct thorough Sales allegations investigations. * Recommend applicable corrective action(s) when applicable to business partners. * Process improvement driven. * Create, update, and retire P&Ps, Standard Operating Procedures and Training documents. * Lead regularly scheduled Sales & Compliance leadership meetings. * Interpret and analyze Medicare, Medicaid, and MMP Required Sales & Marketing Reporting Technical Specifications. * Create and maintain monthly and quarterly Sales Complaint Key Performance Indicator (KPI) reports. * Review and interpret internal Sales dashboards for outliers and deeper dive research. * Manage compliance Sales Allegations, Secret Shops, and recommend corrective action plans for deficiencies found. * Responds to legislative inquiries/ Sales complaints (state insurance regulators, Congressional, etc.). * Leads projects to achieve Sales compliance objectives. * Interprets and analyzes state and federal regulatory manuals and revisions. * Interpret and analyze federal and state rules and requirements for proposed & final rules for Sales Oversight. * Interact with Molina external customers, via verbal and written communication. * Ability to work independently and set priorities. Experience * 2-4 years' related compliance work experience * Exceptional communication skills, including presentation capabilities, both written and verbal. * Excellent interpersonal communication and oral and written communication skills. * High level Interaction with Leadership. * Sales Allegation Investigations * Policy & Procedures Pay Range: $80,168 - $116,835 / 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.

Provides support for pharmacy technician activities. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Shift: (11 AM-7:30 PM MST or 12:30-9 PM MST) Essential Job Duties * Performs initial receipt and review of non-formulary or prior authorization requests against pharmacy plan approved criteria; requests additional information from providers as needed to properly evaluate requests. * Accurately enters approvals or denials of requests. * Facilitates prior authorization requests within established pharmacy policies and procedures. * Participates in the development/administration of pharmacy programs designed to enhance the utilization of targeted drugs and identification of cost-saving pharmacy practices. * Identifies and reports pharmacy departmental operational issues and resource needs to appropriate leadership. * Assists Molina member services, pharmacies, and health plan providers in resolving member prescription claims, prior authorizations, and pharmacy service access issues. * Articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed. Required Qualifications * At least 2 years pharmacy technician experience, or equivalent combination of relevant education and experience. * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Ability to abide by Molina policies. * Ability to maintain attendance to support required quality and quantity of work. * Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA). * Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers. * Excellent verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software program(s) proficiency. 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: $21.65 - $31.71 / 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.

Provides lead level support in the execution of merger and acquisition transactions and actively contributes to the advancement of Molina Healthcare's overall growth strategy. Duties include strategically identifying, sourcing, evaluating, and executing Molina Healthcare's inorganic growth initiatives, including acquisitions, divestitures, joint ventures, and strategic partnerships. Collaborates closely with Molina Healthcare's Mergers and Acquisitions (M&A) and operational leadership to evaluate and execute meaningful growth initiatives. Job Duties * Partners with internal stakeholders to research and assess potential acquisition opportunities. * Develops financial and valuation models and perform comprehensive analyses to assess potential transaction opportunities and influence decision-making. * Coordinates all aspects of the M&A process, including due diligence, data rooms, transaction documents, internal updates, and senior management/board presentations. * Coordinates deal activities among internal cross-functional teams and external parties. * Embraces ad-hoc assignments and projects across Corporate Development and in support of post-acquisition integration efforts. * Actively participates in reviewing and negotiating transaction agreements. * Establishes a robust understanding of customer segments, industry trends, market positioning, and emerging opportunities. Required Qualifications * At least 5 years' experience in investment banking, private equity, management consulting, corporate development, or similar environments, or equivalent combination of relevant education and experience * Exceptional financial modeling, interpersonal, and project management skills. * Attention to detail. Strong work ethic. Proactive self-starter. Calm under pressure. Able to adapt to fast-paced, ambiguous environments. High learning agility. Consummate teammate. * Excellent written communication skills. Strong spoken communication skills. Preferred Qualifications * Bachelor's degree in Finance, Economics, Mathematics, or a similar field. * Previous healthcare experience 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: $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.

Leads and supervises a team of pharmacy call center representatives and operations staff responsible to ensure that members have access to medically necessary prescription drugs. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job Duties * Hires, trains, develops, and supervises a team of pharmacy service representatives supporting processes involved with Medicare Stars and Pharmacy quality operations. * Ensures that average phone call handle time, average speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. * Ensures that adequate staffing coverage is present at all times of operation. * Assists pharmacy leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions. * Responsible for key performance indicators (KPI) reporting to department leadership on a monthly basis. * Participates, researches, and validates materials for both internal and external program audits. * Acts as liaison to internal and external customers to ensure prompt resolution of identified issues. * Assists pharmacy leadership in the collection and tabulation of data for reporting purposes and maintains files of confidential information submitted for review. * Assures that activities and processes are compliant with CMS, National Committee of Quality Assurance (NCQA) guidelines, and Molina policies and procedures. * Participates in the daily workload of the department, performing Representative duties as needed. * Facilitates interviews with pharmacy service representative job applicants, and provides hiring recommendations to leadership. * Provides coaching for pharmacy representatives, and helps identify and provide for training needs in collaboration with pharmacy leadership. * Communicates effectively with practitioners and pharmacists. * Collaborates with and keeps pharmacy leadership apprised of operational issues, including staffing resources, program and system needs. * Assists with development of and maintenance of pharmacy policies and procedures * Participates in the development of programs designed to enhance preferential or required targeted drugs or supplies. Required Qualifications * At least 5 years of experience in health care, preferably within a health-related call center environment, or equivalent combination of relevant education and experience. * Knowledge of prescription drug products, dosage forms and usage. * Experience designing, implementing, monitoring, and evaluating metrics that measure call center agent productivity. * Working knowledge of medical/pharmacy terminology * Excellent verbal and written communication skills. * Microsoft Office suite, and applicable software program(s) proficiency. Preferred Qualifications * Supervisory/leadership experience. * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Call center experience. * Managed care experience. 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: $55,706.51 - $80,464.96 / 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.

Provides support for coordination of benefits review activities that directly impact medical expenses and premium reimbursement. Responsible for primarily coordinating benefits with other carriers responsible for payment. Facilitates administrative support, data entry, and accurate maintenance of other insurance records. **Job Duties** + Provides telephone, administrative and data entry support for the coordination of benefits (COB) team. + Phones or utilizes other insurance company portals to validate state, vendor, and internal COB leads. + Updates the other insurance table on the claims transactional system and COB tracking database. + Review of claims identified for overpayment recovery. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + At least 1 year of administrative support experience, or equivalent combination of relevant education and experience. + Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. + Strong verbal and written communication skills. + Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders. + Microsoft Office suite proficiency. **PREFERRED QUALIFICATIONS:** + Health care experience 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: $21.65 - $31.71 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Become a part of our caring community and help us put health first As a therapist at CenterWell Home Health, you'll play a vital role in helping patients regain strength, mobility and independence-all from the comfort of their homes. By delivering personalized care that focuses on rehabilitation and functional improvement, you'll empower individuals to overcome physical limitations, perform everyday activities with confidence and enjoy a better quality of life. As a Home Health Occupational Therapist, you will: * Assess/screen patient's daily living/work-related skills and develop therapeutic retraining programs with measurable objectives. Administer and interpret diagnostic and prognostic tests of function to patients in their homes or other settings to assist the physician in evaluating the patient's level of function. * Confer with the patient's physician and other health care team members and participate in development/revision of the Plan of Care Treatment. * Provide therapeutic treatment and instruction to patients in accordance with physician orders to improve/restore strength, coordination, range-of-motion and function or teach compensation measures. * Review/expand the retraining programs in a manner consistent with the behavioral goals of each patient and within the guidelines of the rehabilitation program as a whole. * Consult with other vocational team members, as appropriate, to develop and implement vocationally oriented plans consistent with the needs and capabilities of patients. * Report patient status and progress to the physician, rehabilitation staff, Clinical Manager, patient and family members. * Participate in care coordination and discharge planning activities and act as a resource to other health care personnel in meeting patient's needs. * Design community reintegration activities to assist the client in the physical reconditioning effort, and/or the psychological adjustment and coordinate the plan with members of the interdisciplinary team. * Recommend and/or design special adaptive equipment for clients to improve residence or working environments or improve their participation in the rehabilitation program and/or community. * Design/train staff and family members to carry out the retraining program including dressing, feeding, grooming and hygiene skills, participate in team and family educational meetings. * Coordinate/oversee/supervise/instruct and evaluates Occupational Therapy Assistant and Home Health Aide performance in implementing occupational therapy services. * Accurately and thoroughly document patients' care observations, interventions and evaluation on the day services are rendered. Ensure that interim (verbal) orders received from the physician are accurately documented and implemented. Submit evaluation, treatment plans and discharge summary to the supervisor and care management staff. Use your skills to make an impact Required Experience/Skills: * Degree from an accredited Occupational Therapy Program * A minimum of six months of occupational therapy experience preferred * Home Health experience a plus * Current and unrestricted OT licensure * Current CPR certification * Good organizational and communication skills * Valid driver's license, auto insurance and reliable transportation. Pay Range * $49.00 - $69.00 - pay per visit/unit * $77,200 - $106,200 per year base pay Scheduled Weekly Hours 20 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $85,400 - $117,500 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Provides entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Enters denials and requests for appeals into information system and prepares documentation for further review. - Researches claims issues utilizing systems and other available resources. - Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. - Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. - Determines appropriate language for letters and prepares responses to member appeals and grievances. - Elevates appropriate appeals to the next level for review. - Generates and mails denial letters. - Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. - Creates and/or maintains appeals and grievances related statistics and reporting. - Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. **Required Qualifications** - At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. - Customer service experience. - Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. - Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). 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: $21.65 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. 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: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.