Molina Healthcare jobs in Buffalo, NY

The Director, Clinical Data Acquisition for Risk Adjustment, is responsible for the implementation, monitoring, and oversight of all chart collection for Risk Adjustment, RADV, or Risk Adjustment-like projects, and other state specific audit projects and deliverables related to accurate billing and coding. This role also works with the Health Plan Risk/Quality leaders to strategically plan for supplemental data source (SDS) acquisition from providers as well as Electronic Medical Record (EMR) access. This position oversees management of training for all CDA team members as well as company Risk Adjustment retrieval and data completeness training, onboarding for CDA team members, vendor management for chart collection vendors, Supplemental data, and chart collection research. **Job Duties** + Plans and/or implements operational processes for Risk Adjustment operations that meet state and federal reporting requirements/rules and are aligned with effective practices as identified in the healthcare quality improvement literature and within Molina plans. + Develops and implements targeted collection of clinical data acquisition related to performance reporting and improvement, including member and provider outreach. + Serves as operations subject matter expert and lead for Molina Risk Adjustment, using a defined roadmap, timeline and key performance indicators. + Collaborates with the national intervention collaborative analytics and strategic teams to deliver value for both prospective and retrospective risk programs. + Communicates with the Molina Plan Senior Leadership Team, including the Plan President, Chief Medical Officer, national Risk Adjustment teams and strategic teams about key deliverables, timelines, barriers and escalated issues that need immediate attention. + Presents concise summaries, key takeaways and action steps about Molina Risk Adjustment processes, strategy and progress to national, regional and plan meetings. + Demonstrates ability to lead and influence cross-functional teams that oversee implementation of Risk Adjustment projects. + Possesses a strong knowledge in Risk Adjustment and RADV to implement effective operations that drive change. + Functions as key lead for clinical chart review/abstraction and team management. This includes qualitative analysis, reporting and development of program materials, templates or policies. Maintains productivity reporting, management and coaching. + Maintains advanced ability to collaborate and Manage production vendor relationships, including oversight, data driven KPI measurement and performance mitigation strategies. **Job Qualifications** **REQUIRED EDUCATION:** Bachelor's Degree in a clinical field, Public Health, Healthcare, or equivalent. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** - 8+ years' experience in managed healthcare, including at least 4 years in health plan Risk Adjustment or clinical data acquisition/chart retrieval roles - Operational knowledge and experience with Excel and Visio (flow chart equivalent). **PREFERRED EXPERIENCE:** - 10+ years' experience with member/ provider (Risk Adjustment) outreach and/or clinical intervention or improvement studies (development, implementation, evaluation) - 3-5 years Supervisory experience. - Project management and team building experience. - Experience developing performance measures that support business objectives. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** - Certified Professional in Health Quality (CPHQ) - Nursing License (RN may be preferred for specific roles) - Certified Risk Adjustment Coder (CRC) 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 - $250,446 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. A Central Fill Pharmacy is a high-volume facility that supports multiple retail pharmacies by preparing and packaging prescription medications in one centralized location. As a member of the inventory team, you would play a key role in the operation by receiving, organizing, and putting away pharmaceutical inventory. This ensures that medications and supplies are accurately stocked and readily available for automated dispensing systems, helping the pharmacy run efficiently and safely. Target Pay: $19-25hr (based on individual experience) Job Requirements/Responsibilities: * Perform inventory management functions, when necessary, such as order filling, receiving, cutting cases, product put-away, process store credit returns, expired/damaged product returns, reconciliation processing, cycle count process, processing shipping and returns to the Distribution Center, product additions and subtractions. * Process inventory workflow of facility in accordance with daily goals and functions * Adherence and compliance to policies, Standard Operating Procedures (SOP's) and Safety guidelines of facility * Communicate with peers and supervisors about operational concerns, assist in resolving these concerns and issues as they arise. Execute planned work assignments as assigned and needed * Comfortable using a computer. Knowledge of Microsoft Office suite preferred. * Adhere to and promote the company's I2CARE/ILEAD Principles * Ability to work independently and in small teams * Any other assigned tasks Minimum Qualifications: * High School Diploma or equivalent * Typically requires 1+ years of related experience. * Self-starter * Ability to execute physical tasks, lifting up to 30lb cases of product during the first 2-3 hours of the shift * Must be computer proficient * Must meet company established attendance requirements and guidelines. Additional/Preferred Qualifications: * Central Fill production and/or previous receiving or inventory warehouse experience preferred * Knowledge/familiarity with production and inventory functions and/or background preferred * 1+ years in inventory receiving highly preferred * Material Handler experience is highly advantageous and preferred Physical Requirements (Lifting, standing, etc.) * Standing and walking frequently throughout shift * Ability to perform lifting (weights based on product)-Pallet jacks, bending, reaching * Must be able to work mandatory overtime Job Hours * Shift: 1st shift * Hours: Monday & Friday 8:00AM - 4:30PM Tuesday/Wednesday/Thursday 7:00AM - 3:30PM * Mandatory Overtime as needed (This description is general in nature and is not intended to be an exhaustive list of all responsibilities. Other duties may be assigned as needed to meet company goals. Hours and responsibilities are subject to change based on the business need) Internal applicants please note: Must not currently be on progressive discipline - written or final written warning. Must be a current McKesson employee who has the completed 90 day probationary period. Please note: If you are still in your probationary period and are interested in this position, please see your supervisor. Your application will be considered if no eligible internal candidates apply. If you have been promoted or transferred into your current position, you should have performed those duties for at least six months to be eligible for consideration. Criteria that is part of the selection process: qualifications, merit, experience and attendance and work record. We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care. The SIU Investigator is also responsible for recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Officers in order to achieve and maintain appropriate anti-fraud oversight. **Job Duties** + Responsible for developing leads presented to the SIU to assess and determine whether potential fraud, waste, or abuse is corroborated by evidence. + Conducts both preliminary assessments of FWA allegations, and end to end full investigations, including but not limited to witness interviews, background checks, data analytics to identify outlier billing behavior, contract and program regulation research, provider and member education, findings identification and communications development, and recommendations and preparation of overpayment identifications and closure of investigative cases. + Completes investigations within the mandated period of time required by either state and/or federal contracts and/or regulations. + Conducts both on-site and desk top investigations. + Conducts low to medium, and extensive investigations, including reviews of medical records and data analysis, and makes determinations as to whether the investigation and/or audit identified potential fraud, waste, or abuse. + Coordinates with various internal customers (e.g., Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to gather documentation pertinent to investigations. + Detects potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns through utilization review. + Prepares appropriate FWA referrals to regulatory agencies and law enforcement. + Documents appropriately all case related information in the case management system in an accurate manner, including storage of case documentation following SIU related requirements. Prepares detailed preliminary and extensive investigation referrals to state and/or federal regulatory and/or law enforcement agencies when potential fraud, waste, or abuse is identified as required by regulatory and/or contract requirements. + Renders provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements. + Interacts with regulatory and/or law enforcement agencies regarding case investigations. + Prepares audit results letters to providers when overpayments are identified. + Works may be remote, in office, and on-site travel within the state of New York as needed. + Ensures compliance with applicable contractual requirements, and federal and state regulations. + Complies with SIU Policies as and procedures as well as goals set by SIU leadership. + Supports SIU in arbitrations, legal procedures, and settlements. + Actively participates in MFCU meetings and roundtables on FWA case development and referral **JOB QUALIFICATIONS** **Required Education** Bachelors degree or Associate's Degree, in criminal justice or equivalent combination of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** + 1-3 years of experience, unless otherwise required by state contract + Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts from opinions. + Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations. + Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems. + Understanding of datamining and use of data analytics to detect fraud, waste, and abuse. + Proven ability to research and interpret regulatory requirements. + Effective interpersonal skills and customer service focus; ability to interact with individuals at all levels. + Excellent oral and written communication skills; presentation skills with ability to create and deliver training, informational and other types of programs. + Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook), SharePoint and Intra/Internet as well as proficiency with incorporating/merging documents from various applications. + Strong logical, analytical, critical thinking and problem-solving skills. + Initiative, excellent follow-through, persistence in locating and securing needed information. + Fundamental understanding of audits and corrective actions. + Ability to multi-task and operate effectively across geographic and functional boundaries. + Detail-oriented, self-motivated, able to meet tight deadlines. + Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities. + Energetic and forward thinking with high ethical standards and a professional image. + Collaborative and team-oriented **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** : + Valid driver's license required. **PREFERRED EXPERIENCE** : At least 5 years of experience in FWA or related work. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : + Health Care Anti-Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). 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: $21.82 - $51.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Lead Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Reporting team. Designs and develops reporting solutions to assist HEDIS Outbound, Inbound extracts, Data Ingestions, Dashboards, Reports & Extracts for rate tracking and other outreach purposes. **ESSENTIAL JOB DUTIES:** -Mentors and leads 2-10 software engineers on multiple projects for project deliverables, assess deliverables' quality, plan and implement corrective and preventive actions to improve application quality. -Evaluates alternative systems solutions and recommends solution that best meets the need of the business. -Develops the BRDs along with business stakeholders, Conceptual Designs for multiple projects concurrently. SOX compliant Project deliveries and Project coordination. -Translates user requirements into overall functional architecture for complex s/w solutions in compliance with industry regulations. -Provides subject matter expertise and reviews applications designs built using .Net Framework 1.1/2.0, C#, VB.NET, ASP.NET, VB6.0, VB Script, Java Script, XML, HTML, DHTML, SharePoint server, BizTalk Server 2004/6, Microsoft SQL Server 2000/5, DTS/SSIS/SSRS on windows platform. -Drives Joint Applications Development session with business stakeholders to define business requirements and provides systems/application expertise for multiple projects concurrently. -Communicates with cross functional teams (and if applicable, vended partners) to coordinate requirements, design and enhancements with the development team(s). -Assesses and analyzes computer system capabilities, work flow and scheduling limitations to determine if requested program or program change is possible within existing system. -Recognizes, identifies and documents potential areas where existing business processes require change, or where new processes need to be developed, and makes recommendations in these areas. -Works independently and resolves complex business problems with no supervision. -Mentors and leads 2-10 systems or programmer analysts on multiple projects for project deliverables, assesses deliverables' quality, plans and implements corrective and preventive actions to improve application quality. -Works with project managers to define work assignments for development team(s). -Identifies, defines and plans software engineering process improvements and verifies compliance. -Mentors and trains systems/programmer analysts on software applications, business domain and design standards. -Conducts peer review of other analysts (internal and contract staff) to ensure standards and quality. -Recommends, schedules and performs software systems/applications improvements and updates. -Conducts studies pertaining to designs of new information systems to meet current and projected needs. -Defines and plans software releases in accordance with other software applications. Assists in the project definition, execution and implementation. Provides application, business process or functional domain leadership/expertise and peer mentoring to IT staff. Provides expertise to one or multiple domain such as application development, business process re-engineering, enterprise integration, logical data modeling, project coordination, estimation, metrics generation, status reporting. Provides thought leadership or hands-on expertise for problem resolution, application enhancements, user training and documentation of business processes. Strong application delivery methodology or SDLC background, functional domain or software engineering expertise or proficiency. Manages small or medium size projects as assigned. -Excellent verbal and written communication skills. -Must be knowledgeable of business processes, industry standard quality norms, systems and applications development best practices, project management methodologies and estimation processes. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline **Required Experience** **-** 5+ years' experience supporting, designing and/or implementing application changes. **Highly Preferred Experience** - 5+ Years of experience in working with **HEDIS** tools such as **Inovalon** or **ClaimSphere** - 5+ Years of experience in working with HEDIS Domain - such as Measure analysis/reconciliation on data w.r.t measure specifications. - 5+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data. - 5+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design - 5+ years of experience in working with **Microsoft T-SQL, Databricks SQL and PowerBI.** - Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage. - Familiarity with Microsoft Azure, AWS or Hadoop. - 3-5 Years of experience with predictive modeling in healthcare quality data. - 5+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among Medicaid, Marketplace and Medicare/MMP. - 5+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. - 5+ Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for quality, finance, and health plan functions - 5 years of experience in working with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics 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.

******Candidates must be located in California and work PST hours.****** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. **KNOWLEDGE/SKILLS/ABILITIES** + Develops, implements, and uses software and systems to support the department's goals. + Develops and generates ad-hoc and standard reports using SQL programming, excel , Databricks and other analytic / programming tools. + Coordinates and oversees report generation by team members and distribution schedule to ensure timely delivery to customers, ensuring the highest quality on every project/request. Responsible for error resolution, follow up and performance metrics monitoring. + Provides peer review of critical reports and guidance on programming / logic improvements; provides guidance to team members in their analysis of data sets and trends using statistical tools and techniques to determine significance and relevance. + Applies process improvements for the team's methods of collecting and documenting report / programming requirements from requestors to ensure appropriate creation of reports and analyses while reducing rework. + Manage the creation of comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures. + Create new databases and reporting tools for monitoring, tracking, and trending based on project specifications. + Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures. + Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. + Maintains SharePoint Sites as needed, including training materials and documentation archives. + Demonstrate Healthcare experience in contract modeling, analyzing relevant Financial and Utilization Metrics of Healthcare. + Must be able to act as a liaison between Finance and Network Contracting as well as other external teams. + Must have experience in Financial modeling, identifying Utilization mgmt. trends and monitor pair mix. + Experience with Medicaid contract analytics is highly preferred. + Experience working on Managed care analytics and healthcare reimbursement models is required. + Must be able to work in a cross functional team. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in Finance, Economics, Computer Science **Required Experience** + 6+ years of progressive responsibilities in Data, Finance or Systems Analysis + Expert knowledge on SQL, PowerBI, Excel, Databricks or similar tools **Preferred Education** Bachelor's Degree in Finance, Economics, Math, Accounting or related fields Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators: + Proactively identify and investigate complex suspect areas regarding contract rate and related medical costs + Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan + Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, etc. + Analysis of trends in medical costs to provide analytic support for finance, pricing, and actuarial functions + Multiple data systems and models + BI tools (Power BI) **Preferred License, Certification, Association** QNXT or similar healthcare payer applications 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: $77,969 - $171,058 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

We are seeking a Senior AI Developer/Engineer to lead the design and deployment of intelligent conversational agents across IT, HR, and enterprise platforms. 1. Develop and implement AI-driven virtual assistants using Moveworks, Oracle GenAI Agents, and Microsoft Azure AI Copilot. 2. Design conversational flows, intents, and memory for multi-turn interactions. 3. Integrate AI agents with enterprise systems like ServiceNow, Oracle HCM, and Microsoft Teams. 4. Create custom agent workflows and automation using APIs and low-code tools. 5. Apply prompt engineering and fine-tune LLMs to ensure accuracy and tone alignment. 6. Implement testing frameworks, QA processes, and user acceptance validation. 7. Manage deployments, monitor performance, and ensure secure data handling. 8. Continuously enhance AI agent capabilities using platform updates and analytics insights. 9. Document architectures, workflows, and operational procedures. 10. Ensure compliance with AI governance, data privacy, and responsible AI principles. 11. Collaborate with cross-functional teams across IT, HR, and AI governance committees. 12. Mentor developers and promote best practices in AI development. 13. Stay current with new Moveworks and Azure AI features for enterprise automation. 14. Strong skills in Python, REST APIs, OAuth 2.0, and enterprise integrations required. 15. Ideal candidate has experience with LLMs, chatbots, and secure cloud AI deployment. **JOB QUALIFICATIONS** **REQUIRED EDUCATION:** Bachelor's Degree in Business Administration or Information Technology or equivalent combination of education and experience **REQUIRED EXPERIENCE:** 5-7 years related experience in a combination of applicable business and business systems **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** **PREFERRED EDUCATION:** **PREFERRED EXPERIENCE:** **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** **STATE SPECIFIC REQUIREMENTS:** 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: $77,969 - $117,000 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for reviewing and resolving member & 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. **KNOWLEDGE/SKILLS/ABILITIES** + Enters denials and requests for appeal into information system and prepares documentation for further review. + Research issues utilizing systems and other available resources. + Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. + Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. + Determines appropriate language for letters and prepare responses to appeals and grievances. + Elevates appropriate appeals to the Appeals Specialist. + Generates and mails denial letters. + Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner. + Creates and/or maintains statistics and reporting. + Works with provider & member services to resolve balance bill issues and other member/provider complaints. **JOB QUALIFICATIONS** **REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:** High School Diploma or equivalency **REQU** **I** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:** + 1 year of Molina experience, health claims experience, OR one year of customer service/provider service experience in a managed care or healthcare environment. + Strong verbal and written communication skills. 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: $21.16 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Molina Medicare Stars Program Manager functions oversees, plans and implements new and existing health care quality improvement initiatives and education programs. Responsible for Medicare Stars projects and programs involving enterprise, department or cross-functional teams of subject matter experts, delivering impactful initiatives through the design process to completion and outcomes measurement. Monitors the programs and initiatives from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management for Stars Program and Quality Improvement activities. **Job Duties** + Collaborates with teams & health plans impacted by Medicare Quality Improvement programs involving enterprise, department or cross-functional teams of subject matter experts, delivering products through the design process to completion. + Supports Stars program execution and governance needs to communicate, measure outcomes and develop initiatives to improve Star Ratings + Plans and directs schedules Program initiatives, as well as project budgets. + Monitors the project from inception through delivery and outcomes measurement. + May engage and oversee the work of external vendors. + Focuses on process improvement, organizational change management, program management and other processes relative to the Medicare Stars Program + Leads and manages team in planning and executing Star Ratings strategies & programs. + Serves as the Medicare Stars subject matter expert in the functional area and leads programs to meet critical needs. + Communicates and collaborates with health plans to analyze and transform needs and goals into functional requirements. + Delivers the appropriate artifacts as needed. + Works with Enterprise and Health Plan l leaders within the business to provide recommendations on opportunities for process improvements. + Monitors and tracks key performance indicators, programs and initiatives to reflect the value and effectiveness of Stars and Quality improvement programs + Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations. + Generate and distribute standard reports on schedule **Job Qualifications** **REQUIRED EDUCATION** : Bachelor's Degree or equivalent combination of education and experience. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : - 3-5 years of Medicare Stars Program and Project management experience. + Demonstrated knowledge of and experience with Star Ratings & Quality Improvement programs - Operational Process Improvement experience. - Medicare experience. - Experience with Microsoft Project and Visio. - Excellent presentation and communication skills. - Experience partnering with different levels of leadership across the organization. **PREFERRED EDUCATION** : Graduate Degree or equivalent combination of education and experience. **PREFERRED EXPERIENCE** : - 5-7 years of Medicare Stars Program and/or Project management experience. - Managed Care experience. - Experience working in a cross functional highly matrixed organization. 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: $77,969 - $171,058 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Looking for a RN that has a current active unrestricted license This a remote role and can sit anywhere within the United States. Work Schedule Monday to Friday - operation hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. **ESSENTIAL JOB DUTIES:** + Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. + Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions. + Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. + Identifies and reports quality of care issues. + Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience. + Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings. + Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. + Supplies criteria supporting all recommendations for denial or modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. + Provides training and support to clinical peers. + Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols. **REQUIRED QUALIFICATIONS:** + At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse (RN). License must be active and unrestricted in state of practice. + Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). + Experience working within applicable state, federal, and third-party regulations. + Analytic, problem-solving, and decision-making skills. + Organizational and time-management skills. + Attention to detail. + Critical-thinking and active listening skills. + Common look proficiency. + Effective verbal and written communication skills. + Microsoft Office suite and applicable software program(s) proficiency. **PREFERRED QUALIFICATIONS:** + Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications. + Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics. + Billing and coding 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: $29.05 - $67.97 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for Molina Healthcare's Protection Services Operations Center (PSOC) by conducting daily investigations activities and ensuring enterprise-wide compliance. Reporting to the Manager, Investigations, this role supports employees, handles incident response, and escalates cases involving Molina facilities or interests as needed. Collaborates closely with PSOC partners, Human Resources, Legal, and other stakeholders to support both routine and complex investigations and helps develop tools and processes that meet evolving business needs. **Job Duties** + Engages in high-stress situations to ensure incident response, threat mitigation, and after-care support for involved workforce members and/or company facilities. + Rapidly responds (in a remote environment) to workforce members involved in workplace violence incidents, threat events, and distressed situations. + With minimal oversight, independently leads or provides support to investigations including: + Collects physical or digital evidence and performs detailed analysis + Conducts and accurately documents interviews + Creates, updates and maintains case management records and systems + Prepares comprehensive, timely, and detailed professional incident reports on all inquiries regarding potential and/or actual investigative matters, including presentations on research findings and necessary recommendations. + Establishes, maintains and promotes successful relationships with law enforcement agencies in all jurisdictions with Molina business/employee interests. + Conducts comprehensive Open-Source Intelligence (OSINT) supporting investigative or threat management initiatives. + Supports Threat Intelligence to include conducting employee safety assessments during situational or environmental responses. + Develops and conducts employee awareness training in security focused areas of responsibility. + May be required to work outside of normal business hours (nights, evenings, and weekends) if responding to emergent investigations or employee welfare concerns. + Coordinates dispatch security personnel to respond to incidents. Coordinates and issues alerts (i.e., BOLO) + Other duties as assigned by management **Job Qualifications** **Required Qualifications:** + At least 2 years of corporate business experience in physical security, investigations, or law enforcement, or equivalent combination of relevant education and experience. + Experience in investigative interviewing techniques. + Exceptional written communication, interpersonal, analytical, and research skills with strong case management expertise. + Naturally curious and enjoys learning new things. + Ability to engage in several tasks at once. + Self-motivated and results oriented. + A problem solver and an analytical thinker. + Superb organizational skills and the ability to delegate effectively to meet delivery targets. + Ability to interact concisely/accurately and positively with leadership and colleagues + Action oriented and driven to achieve results in a positive manner, displaying ethical behavior and integrity. + Strong grasp and hands-on experience in physical security. + Situational awareness and responding to incidents involving employee and property threats. + Experience with creation of metrics, reporting and analysis. + Familiarity with best practices and standards and experience with industry standard tools and concepts. **Preferred Qualifications:** + Experience in an operations center preferred 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: $21.82 - $51.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. Key Responsibilities: Pick, pack and ship prescriptions directly to retail pharmacies and end-customer in a fast-paced semi-automated production environment. Ability to fill, pack and ship prescriptions with 100% accuracy and efficiency using Standard Operating Procedures (SOP) and McKesson supported hardware and software. Able to read computer generated screens, find indicated merchandise on labeled shelves, and verify quantity and dosage of the product before selecting for order. Examines stock and distributes materials in inventory. Also responsible for maintenance and housekeeping, proper storage of goods, ensuring correct reliable shelf labels for merchandise locations, and other duties as assigned. May require mandatory overtime based on business need. Minimum Requirements: Typically requires 1+ years of related experience Critical Skills: 0-1 years of proven experience with excellent attention to detail 0-1 years' experience in a quality focused role Additional Qualifications/Job Information: Excellent attention to detail Quality focused Physical Requirements: Able to select and lift objects from shelves and carry to order filling line. Able to consistently carry 20-30 lbs. of merchandise short distances and 15 lbs. of merchandise on an extended basis from order filling station to conveyor. Must be able to walk and stand throughout the entire shift. Pay: $18.00/hour plus $1.00/hour shift differential Work Schedule: Full time, 40 hours a week Sunday to Thursday 2pm to 10:30pm Internal Applicants: Must meet established attendance requirements. Must not currently be on progressive discipline - written or final written warning. Must currently maintain acceptable standards and quality in present position. Current McKesson employee who has completed 90 day probationary period . Please note if you are still on your probationary period and are interested in this position please see your supervisor, if no internal candidates whom have completed their probation apply then you may put in a internal application for consideration. We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

Provides entry level analyst support for claims research activities. This role plays a pivotal role in ensuring the timely and accurate resolution of provider-submitted claims issues. This role requires a keen understanding of medical claims processing, strong analytical skills, and the ability to effectively triage issues to the appropriate department for further investigation or correction. This is a production-based role, with clear expectations for meeting production and quality standards. **Job Duties** + Reviews and analyzes claims-related issues submitted by providers to identify potential root causes quickly and accurately. + Triages issues based on type and complexity, assigning them to the appropriate department or team for further research or correction. + Leverages knowledge of claims processing workflows, billing practices, and regulatory guidelines to provide accurate assessments. + Meets quality and production goals. + Maintains detailed records of claim reviews and resolutions. + Identifies trends in submitted issues to inform process improvements and reduce recurring errors. + Provides feedback and recommendations for process improvements. + Completes training and development activities to stay current with industry standards and best practices. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + At least 1 year of experience in claims processing or operations or equivalent combination of relevant education and experience + Basic knowledge of medical billing and basic claims processes. + Problem-solving skills + Verbal and written communication skills and ability to collaborate + Ability to work independently and as part of a team + Microsoft Office suite/applicable software program(s) proficiency **PREFERRED QUALIFICATIONS:** + Experience with process improvement methodologies. + Knowledge of industry regulations and compliance standards. + Familiarity with systems used to manage claims inquiries and adjustment requests + Understanding of billing and coding procedures + Experience with Medicaid, Medicare, and Marketplace claims 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: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Marketplace Facilitated Enroller (MFE) is responsible for identifying prospective members that do not have health insurance and assisting with the enrollment process ultimately making it easier for them to connect to the care they need. The MFE conducts interviews and screens potentially eligible recipients for enrollment into Government Programs such as Medicaid/Medicaid Managed Care, Child Health Plus and Essential Plan. Additionally, the MFE will assist in enrollment into Qualified Health Plans. The MFE must offer all plans and all products. MFEs assist families with their applications, provides assistance with completing the application, gathers the necessary documentation, and assists in selection of the appropriate health plan. The Enroller provides information on managed care programs and how to access care. The MFE is responsible for processing paperwork completely and accurately, including follow up visit documentation and other necessary reports. The MFE is also responsible for assisting current members with recertification with their plan. MFEs must source, develop and maintain professional, congenial relationships with local community agencies as well as county and state agency personnel who refer potentially eligible recipients. **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for achieving monthly, quarterly, and annual enrollment goals and growth targets, as established by management. + Interview, screen and assist potentially eligible recipients with the enrollment process into Medicaid/Medicaid Managed Care, Child Health Plus the Essential Plan and Qualified Health Plans for Molina and other plans who operate in our service area + Meet with consumers at various sites throughout the communities + Provide education and support to individuals who are navigating a complex system by assisting consumers with the application process, explaining requirements and necessary documentation + Identify and educate potential members on all aspects of the plan including answering questions regarding plan's features and benefits and walking client through the required disclosures + Educate members on their options to make premium payments, including due dates + Assist clients with choosing a plan and primary care physician + Submit all completed applications, adhering to submission deadline dates as imposed by NYSOH and Molina enrollment guidelines and requirements + Responsible for identifying and assisting current members who are due to re-certify their healthcare coverage by completing the annual recertification application including adding on additional eligible family members + Respond to inquiries from prospective members and members within the marketing guidelines + Must adhere to all NYSOH rules and regulations as applicable for MFE functions + Outreach Projects + Participate in events and community outreach projects to other agencies as assigned by Management for a minimum of 8 hours per week + Establish and maintain good working relationships with external business partners such as hospital and provider + organizations, city agencies and community-based organizations where enrollment activities are conducted + Develop and strengthen relations to generate new opportunities + Attend external meetings as required + Attend community health fairs and events as required + Occasional weekend or evening availability for special events. **JOB QUALIFICATIONS** **Required Education** HS Diploma **Required Experience** + Minimum one year of experience working with State and Federal Health Insurance programs and populations + Demonstrated organizational skills, time management skills and ability to work independently + Ability to meet deadlines + Excellent written and oral communication skills; strong presentation skills + Basic computer skills including Microsoft Word and Excel + Strong interpersonal skills + A positive attitude with ability to adapt to change + Must have reliable transportation and a valid NYS drivers' license with no restrictions + Knowledge of Managed Care insurance plans + Ability to work with a diverse population, including different ethnicities, cultural backgrounds, and/or underserved communities + Ability to work a flexible schedule, including nights and weekends **Required License, Certification, Association** Successful completion of the NYSOH required training, certification and recertification **Preferred Education** AA/AS - Associates degree **Preferred Experience** Previous experience as a Marketplace Facilitated Enroller - Bilingual - Spanish & English 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: $18.04 - $42.2 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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. - 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: $21.16 - $31.71 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Manages people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management, rather than the application of expertise in a specialized functional field of knowledge although they may have technical team members. **Expanded Scope:** The Senior Project Manager for Claims Operations drives complex, multi-workstream initiatives that span people, process, data, and technology. Key areas include: + Strategy & Road mapping: Translate business strategy into a prioritized project roadmap; define scope, OKRs/KPIs, value hypothesis, and measurable success criteria (e.g., first-pass resolution, auto-adjudication rate, claims cycle time, audit findings, cost-to-serve). + Process Optimization: Lead current/future-state mapping, root cause analysis, and continuous improvement (Lean/Six Sigma). Design scalable workflows and controls across intake, adjudication, adjustments, appeals/grievances, and payment integrity. + Technology Enablement: Oversee requirements, configuration, and testing for platforms such as Salesforce (case management, integrations), QNXT (or similar core claims), RPA/automation, and analytics/reporting (e.g., SQL/Excel, BI tools). + Delivery Excellence: Plan and execute across Waterfall/Agile or hybrid approaches; lead UAT, cutover, and post-go‑live; steward change management (training, SOPs, job aids, communications). + Risk, Compliance & Quality: Ensure alignment to CMS, HIPAA, state regulations, and audit readiness. Establish governance, RAID (risks/assumptions/issues/dependencies), and quality gates throughout delivery. + Vendor & Stakeholder Management: Manage SOWs and partner performance; facilitate executive steering, operational readiness, town halls, and cross-functional standups. + People Leadership & Culture: Model a high-performance, collaborative culture; mentor PMs/analysts; promote data-driven decision making and continuous improvement. **KNOWLEDGE/SKILLS/ABILITIES** + **Project & Portfolio Leadership** + Leads high dollar, multi-workstream programs; sets cadence (steering committees, status reports, dashboards), manages budget, resources, and critical path. + Balances capacity across initiatives; aligns with PMO standards, stage gates, and financial controls. + **Operational & Regulatory Acumen (Healthcare/Claims)** + Deep understanding of claims lifecycle, EDI transactions, payment integrity, provider data, appeals/grievances, and audit/compliance (CMS, HIPAA, NCQA, state regs). + Designs and embeds controls, SLAs, and quality checks to support audit readiness and reduce rework. + **Process Improvement & Change Management** + Applies Lean/Six Sigma for waste reduction and throughput gains + Executes structured change management including stakeholder engagement, training plans, SOPs/job aids, and communications. + **Technical Fluency & Data Literacy** + Translates business needs into requirements and test cases; manages integrations across Salesforce, core claims (e.g., QNXT), and data pipelines. + Builds and interprets KPI dashboards; uses SQL/Excel or BI tools to analyze performance and inform decisions. + **Communication & Influence** + Crafts clear exec-ready updates, risk narratives, and decision papers; negotiates tradeoffs; escalates with options and quantified impacts. + Facilitates across operational, clinical, compliance, finance, and IT stakeholders. + **Execution Excellence** + Strong organization, prioritization, and time management in fast-paced environments; anticipates dependency and adoption risks; drives on-time, on-budget delivery. **Tools/Methods (examples):** Salesforce, QNXT (or similar core claims), JIRA/Azure DevOps, MS Project/Smartsheet, Visio/Miro/Lucid, SQL, Excel, PowerPoint, Power BI/Tableau, Confluence, ServiceNow; Lean/Six Sigma; Agile/Waterfall/Hybrid. **JOB QUALIFICATIONS** **Required Education** + Bachelor's Degree or equivalent combination of education and experience **Required Experience** + 5-7 years of project/program management with direct impact on Claims Operations (adjudication, configuration, appeals/grievances, payment integrity, provider data). **Preferred Education** + Graduate Degree or equivalent combination of education and experience + Formal training/coursework in project management, process improvement, change management, or healthcare operations. + Specialized training in Salesforce administration, process mapping, UAT/QA, or data analytics. **Preferred Experience** + 7-9 years of project/program management with direct impact on Claims Operations (adjudication, configuration, appeals/grievances, payment integrity, provider data). + Proven leadership of multi-vendor, multi-system implementations (e.g., Salesforce + claims core + data/BI) with hybrid Agile/Waterfall delivery. + Track record in process mapping, workflow redesign, automation (RPA/integration), and control design to improve accuracy and cycle times. + Experience creating and delivering training, SOPs, job aids, and communications; leading readiness, cutover planning, and post-go live stabilization. + Hands-on governance, quality assurance, risk management, and escalation handling in a regulated environment (CMS, HIPAA, state). + Proficiency with Salesforce, QNXT (or similar), SQL, Excel, JIRA/Azure DevOps, and PM/visualization tools (MS Project/Smartsheet, Power BI/Tableau). + Experience facilitating high-visibility forums (executive steering, town halls, implementation readiness reviews); prior people leadership or mentoring of PMs/analysts is a plus. + Strong analytical, organizational, and communication skills; adept at managing multiple priorities and influencing across levels. **Preferred License, Certification, Association** + PMP (Project Management Professional) strongly preferred. + Lean Six Sigma Black Belt preferred (Green Belt considered). + Agile/Scrum certification (e.g., CSM, PMI-ACP, SAFe) desirable. + Salesforce Administrator or relevant platform certification a plus. 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: $77,969 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job SummaryLeads and supervises a team supporting non-clinical healthcare services activities for care management, care review, utilization management, transitions of care, behavioral health, long-term services and supports (LTSS), and/or other program specific service support - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Supervises healthcare services operations support team members within Molina's clinical/healthcare services function, which may include care review, care management, and/or correspondence processing, etc. - Researches and analyzes the workflow of the department, and offers suggestions for improvement and/or changes to leadership; assists with the implementation of changes. - Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance. - Provides regular verbal and written feedback to staff regarding performance and opportunities for improvement. - Assists in the development and implementation of internal desktop processes and procedures. - Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers. Required Qualifications- At least 5 years of operations or administrative experience in health care, preferably within a managed care setting, or equivalent combination of relevant education and experience. - Strong analytic and problem-solving abilities. - Strong organizational and time-management skills. - Ability to multi-task and meet project deadlines. - Attention to detail. - Ability to build relationships and collaborate cross-functionally. - Excellent verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Supervisory/leadership 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: $64,350 - $106,214 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. **KNOWLEDGE/SKILLS/ABILITIES** + Establish and maintain internal standard operating procedures, and enterprise-wide policies and procedures pertaining to Provider functions ensuring alignment with business objectives. + Collaborate with departments on issues related to provider, including but not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims, Provider Services and Contracting. + Assist in design and development of new programs as related to transitions and implementations of existing plans with regards to provider data. + Organizational expert in responding to legislative and regulatory developments and audits as it relates to provider information. Supports others in facing out to regulators in developing and implementing appropriate Corrective Action Plans for submission of provider network files, etc. + Act as an expert in handling complaints and other escalated issues from internal customers. **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. \#PJCore Pay Range: $80,412 - $188,164 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job SummaryProvides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job Duties - Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. - Provides coordination and processing of pharmacy prior authorization requests and/or appeals. - Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. - Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. - Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. - Assists members and providers with initiating verbal and written coverage determinations and appeals. - Records calls accurately within the pharmacy call tracking system. - Maintains established pharmacy call quality and quantity standards. - Interacts with appropriate primary care providers to ensure member registry is current and accurate. - Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. - Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications - At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. - Excellent customer service skills. - Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. - Ability to multi-task applications while speaking with members. - Ability to multi-task applications while speaking with members. - Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors. - Ability to meet established deadlines. - Ability to function independently and manage multiple projects. - Excellent verbal and written communication skills, including excellent phone etiquette. - Microsoft Office suite (including Excel), and applicable software program(s) proficiency. Preferred Qualifications - 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. - Health care industry 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: $21.16 - $28.82 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

This position will be responsible for supporting the execution of merger and acquisition transactions and will actively contribute in advancing Molina Healthcare's overall growth strategy. The role entails working closely with the senior members of the Corporate Development team and will actively interact with the business leaders and senior management team at Molina. The ideal candidate will have at least two years of experience as an analyst at an investment bank or similar firm. **Knowledge/Skills/Abilities** - Develop financial models and perform analyses to assess potential acquisition, joint venture and other business development opportunities (i.e., discounted cash flow, internal rate of return and accretion/dilution) - Prepare ad-hoc analyses and presentations to help facilitate various discussions - Research and analyze industry trends, competitive landscape and potential target companies - Coordinate deal activities among internal cross-functional teams and external parties - Coordinate due diligence and closing-related activities - Actively participate in reviewing and negotiating transaction agreements - Prepare board and senior management presentations **Job Qualifications** **REQUIRED EDUCATION:** Bachelor's degree in Accounting or Finance or related fields **REQUIRED EXPERIENCE:** + Minimum 5 years' experience in financial modeling and analysis + Ability to synthesize complex ideas and translate into actionable information + Strong analytical and modeling skills + Excellent verbal and written communication skills + Highly collaborative and team-oriented with a positive, can-do attitude + Ability to multi-task, set priorities and adhere to deadlines in a high-paced organization **PREFERRED EXPERIENCE:** + Prior analyst experience in investment banking strongly preferred + Healthcare industry experience preferred **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. \#PJCorp \#LI-AC1 Pay Range: $80,412 - $156,803 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.