Molina Healthcare jobs in Council Bluffs, IA

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.

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.

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.

Responsible for maximizing product performance and value to Tenet Patient Financial Services, its clients and the healthcare market through effective supervision, direction and operation of the government programs product and the coordination of its delivery through field operation offices. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Provides overall supervision of Government Programs for assigned division including direction, knowledge, and resources to management and staff to enable them to expedite governmental program recovery and decrease facility bad debt. * Ensures staff understanding and application of local, state and federal laws and guidelines. * Develops and delivers Eligibility Program training to divisional staff and its clients. * Provides direction to staff on issues/questions relating to Government Programs. * Develops, refines, and manages the product to maximize operational goals and objectives while working with the management team and staff. * Monitors and builds team morale and productivity as measured against planned objectives. * Identifies key performance indicators and utilizes them to track and manage product performance. FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense): N/A * Scope: Multiple small locations, or single medium sized location, or single large sized location SUPERVISORY RESPONSIBILITIES This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. * Direct Reports (titles) Patient Advocate and Lead, EES Financial Counselor and Lead. Typically, a 1:12 ratio * Indirect Reports (titles) Clerical Support, EES KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Working familiarity with the rules and regulations pertaining to Federal, State and County programs * P/C systems literate including Windows, and Microsoft Outlook, Excel and Word programs * Ability to work independently * Detail oriented, with strengths in dealing with multiple facilities, Supervisors, and Hospital platforms * Ability to prioritize and manage multiple tasks with efficiency * Excellent oral and written communication, interpersonal, organizational and management skills Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * Bachelors Degree in Business Administration, Marketing and/or related field or equivalent experience * 3 - 5 years experience in healthcare finance or revenue cycle * Most recent 3 years experience in Federal, State and Local government programs * 2 - 3 years supervisory experience in Federal, State and Local government programs * Working knowledge of healthcare products PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to sit and work at a computer terminal for extended periods of time. * Must be able to walk through a hospital environment, including across broad campus settings and Emergency Department environments, and visit patients at bedside. * Ability to travel. WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Both Hospital and Office facilities, in direct contact with Patients and Staff OTHER * Must be able to travel. As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! **********

******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.

Responsible for screening self-pay patients at hospital bedside for eligibility in various governmental and non-governmental programs. Responsible for identifying all sources of potential payors including auto insurance, Workers' Compensation, commercial insurance, private insurance, TPL, etc. to route account appropriately in the Patient Accounting environment. Also responsible for obtaining and completing the Confidential Financial Statement form and assisting patients in the process of applying for any benefits for which they may be eligible. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Conducts interviews with patients and/or family members. * Records and maintains complete documentation of activities performed on account while in-house and during the Patient accounting cycle. * Performs financial clearance function including collections. Cancels accounts that have not had any patient cooperation and are not eligible for any programs and prepares accounts for Financial Assistance review. * Follows up on EES assigned accounts to ensure follow-through on Government application submitted. Develops a working relationship with patients, based on good communication skills, enabling accounts to be processed quickly with government program eligibility. * Conducts field visits to patient homes for skip tracing and or assisting patient with documents. * Notifies hospital case management, social services and admissions staff of case screening determinations and outcomes via verbal and written communication. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Working familiarity with the rules and regulations pertaining to Federal, State and County programs * P/C systems literate including Windows, and Microsoft Outlook, Excel and Word programs * Ability to work independently * Excellent oral and written communication skills, as well as the clear understanding of the English language * Detail oriented, with strengths in dealing with multiple facilities, Supervisors, and Hospital platforms * Ability to prioritize and manage multiple tasks with efficiency * Bi-lingual preferred (Spanish) Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * High School diploma or equivalent * Minimum 2 years work experience with Social Services or Hospital Admitting or related area PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to sit and work at a computer terminal for extended periods of time * Must be able to walk through a hospital environment, including across broad campus settings and Emergency Department environments, and visit patients at bedside * Ability to travel if required WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Both Hospital and Office facilities, in direct contact with Patients and Staff OTHER * Some travel may be required As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! **********

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.

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.

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.

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 Speech Language Pathologist, you will: * Evaluate, direct and provide speech/language pathology service to patients in the home or facility * Participate in the development and periodic review of the Plan of Treatment and Plan of Care. * Utilize professional skills and judgment in assessing and treating disorders of speech, voice, language, hearing and swallowing to prevent, identify, evaluate and minimize the effects of such disorders and conditions. * Administer and interpret diagnostic tests and applications of therapeutic treatments including audio logic screening. * Observe, record and report changes in the patient's condition and response to treatment to supervisor and/or the physician. * Provide instruction and training to patients in use of alternative communication systems when appropriate. * Provide counsel and instruction to patients, families and healthcare staff. * Maintain and submit documentation as required by the Company and/or facility. Prepare and submit timely written reports of evaluations, visits, summaries, care plans, care coordination activities and progress reports as required by Company policy. * Participate in care coordination activities and discharge planning. * Maintain the highest standards of professional conduct in relation to information that is confidential in nature. Share information only when the recipient's right to access is clearly established and the sharing of such information is clearly in the best interests of the patient. * Attend, participate in and/or conduct internal staff development programs, obtain continuing education as required by Company policy, regulation. Use your skills to make an impact Required Experience/Skills: * Meet the education and experience requirements for Certification of Clinical Competence in Speech Language Pathology or Audiology granted by ASHA * Minimum of six months experience as a speech therapist / speech language pathologist * Home Health experience a plus * Current and unrestricted license * Current CPR certification * Good organizational and communication skills * A valid driver's license, auto insurance, and reliable transportation are required. Pay Range * $49.00 - $69.00 - pay per visit/unit * $77,200 - $106,200 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.

Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. - Facilitates comprehensive waiver enrollment and disenrollment processes. - Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. - Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. - Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. - Assesses for medical necessity and authorizes all appropriate waiver services. - Evaluates covered benefits and advises appropriately regarding funding sources. - Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. - Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. - Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. - Identifies critical incidents and develops prevention plans to assure member health and welfare. - Collaborates with licensed care managers/leadership as needed or required. - 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications - At least 2 years health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. -Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. - In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). - Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. - Demonstrated knowledge of community resources. - Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. - Ability to operate proactively and demonstrate detail-oriented work. - Ability to work independently, with minimal supervision and self-motivation. - Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations. - Ability to develop and maintain professional relationships. - Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. - Excellent problem-solving, and critical-thinking skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. - In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). Preferred Qualifications - Certified Case Manager (CCM), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice. - Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $25.2 - $56.17 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

This position is responsible for providing HIM support in maintaining the Department's paper and electronic health record system. The HIM Specialist Sr will have an understanding of privacy and security guidelines related to patient information and maintain HIPAA as well as keep all patient information confidential. The key duties of this position rely heavily on the ability to learn, and navigate efficiently within, an electronic health record. The incumbent must be able to communicate both orally and in writing clearly and effectively in the English language; able to work in a fast-paced environment; and develop sound professional working relationships. This position is responsible for advanced functions within the Health Information Management Department. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. * Document Imaging (Pages/Hour) * Prepping * Scanning * Quality Review/Validation/Indexing * HIM Spec Sr will be responsible for function(s) (as assigned by HIM Leadership to include not limited to, prepping, scanning and/or QX/Indexing) within Document Imaging to ensure records are prepped, scanned and QC/Indexed into the Document Management Solution/EMR in a timely manner. * For paper-based sites scanning and uploading medical records into a document management application (i.e. VitalChart ChartFlow (formerly EvriChart)) for remote coding access, include data related to prepping records to scan. * Document Chart Analysis (Records/Hr by patient type): Analyze medical records for completion; assign and reassign provider deficiencies as needed in accordance with regulatory guidelines and in compliance with facility timely completion policy (as assigned by HIM Leadership) * Support Missing Documentation and Provider Queries as needed * Complete birth and or death certificate in accordance with state law including contact with mothers and father within facility specific timeframe as needed. * Chart Pick up (Rounding) and Reconciliation * Perform Data Integrity duties as assigned (chart correction, dup med rec, etc...) * Meet Productivity expectations based on job function as applicable (document imaging / document analysis) * Maintain productivity metrics and time for productivity monitoring. * Assist internal and outside agencies with information regarding patient records ensuring request are prioritized appropriately as needed * Answer phones, process continuity of care requests, record retrieval, record filing (as assigned by HIM Leadership) * Other duties as assigned KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * PC Skills - demonstrates proficiency in keyboard operations, Microsoft Office applications and others as required * Customer Orientation - establishes and maintains long term customer relationships, building trust and respect by consistently meeting and exceeding expectations * Privacy and Security - demonstrates an understanding of the importance of providing privacy and security of all patient information * Vital Statistics - birth certificate and paternity acknowledgement * Organization - establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and keen ability to multi-task * Quality Orientation - accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time * Work Independently - is self-supporting; not needing to rely on others to complete a job. Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * Minimum: High School diploma or equivalent * Preferred: Two (2) years' experience in a hospital Health Information Management Department CERTIFICATES, LICENSES, REGISTRATIONS * Preferred: RHIT or RHIA Certification PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to sit for extended periods of time * Must be able to efficiently use computer keyboard and mouse to perform coding assignments * Ability to lift up to twenty-five (25) pounds WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Pleasant inside environment * Light physical effort * Intense mental concentration stress * Subject to exposure to infectious conditions and minor hazards such as muscle sprains, cuts, and bruises OTHER * The ideal candidate will have previous Health Information Management experience As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! **********

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.

Responsible for providing guidance and mentoring of new and/or existing staff with daily work effort and proper handling of accounts. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Provides daily support/mentoring/training to new hires as well as existing Patient Access staff. Provides assistance in managing escalated issues as needed. * Assists in preparation for both short and long range planning recommendations for all Registration Process areas including; Admitting, Centralized Scheduling, Emergency Department and any on or offsite clinics. * Maintains positive customer service at all times, assisting staff in resolving issues. * Enforces departmental policies, practices, procedures and work rules in accordance with approved department and hospital policies and assists in the development and implementation of new policies according to hospital and corporate guidelines. * Responsible for the monitoring of daily activity and completion of performance and metric reports such as financial clearance reports; also can perform special projects and reporting when assigned. * Perform all Patient Access functions as needed. * Acts as part of the management team to ensure that the group is meeting all operational goals. SUPERVISORY RESPONSIBILITIES This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. * Direct Reports (titles) - Rep, PA I-IV KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Excellent interpersonal and organizational skills * Demonstrated leadership abilities * Thorough knowledge of computer systems in Health Care Information System * Clear understanding of Revenue Cycle Management and Regulatory Agencies required * Ability to receive and express detailed information through oral and written communications. Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * High School Diploma or equivalent. * College degree preferred. * 2 or 4 year college degree in Business, Accounting, Medical Administration or related area preferred * 4 plus years experience in medical facility, health insurance, or related area * 5 plus years experience in Patient Access preferred * 2 plus years in supervisory or lead role preferred PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Must be able to work in sitting position WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Hospital Work Environment OTHER * Must be available to work hours and days as needed based on departmental/system demands * Must be "on-call" as needed As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! **********

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.

Become a part of our caring community and help us put health first Make a meaningful impact every day as a CenterWell Home Health Weekend 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. The Baylor RN (working Thursday - Sunday) directly completes and oversees development/ of the plan of treatment as approved by physician, performs ongoing evaluation of patient needs and coordinates team of professionals and other licensed clinicians and home health aides to ensure optimal clinical outcomes. Works with physician and/or referral source to obtain all pertinent clinical information for optimal assessment generation. Ensures consistent team care scheduling and dissemination of updated clinical information. Coordinates assigned care team members and resources. Maintains focus on all healthcare quality and affordability initiatives (HCQAI's). Established productivity standards and performance will be monitored and measured under general supervision of the Clinical Field Staff Supervisor (CFSS) or above. Essential Functions: * Performs or delegates the initial and ongoing evaluation of patient needs within their scope of practice * Routinely complete Start of Care/Resumption of Care/Recertification/Discharge of OASIS visits and may occasionally need to provide routine visits based on individual patient needs and branch expectations * Ensures plan of care incorporates and guides appropriate teaching related to health maintenance, prevention and safety * Coordinates available resources to manage care plan and ensures stated outcomes are achieved * Periodically reassesses or delegates the reassessment of patient needs and revises care plan as necessary * Assures appropriate care of patient is met through the start of care assessment completion. * Promotes/coordinates communication between team members, attending physicians, appropriate administrative staff, referral sources and external case managers to ensure appropriateness of care * coordination and communicates any necessary changes to the plan of care * Ensures patient needs are identified and qualified caregivers are assigned to all cases within their scope of practice * Participates in special projects and performs other duties as assigned Use your skills to make an impact Required Experience/Skills: * Bachelor of Science degree in Nursing (BSN) preferred * At least 2 years clinical home care experience * Current CPR certification & active RN License * OASIS proficiency * Excellent verbal and written communication skills * Excellent interpersonal skills * Knowledge of state and federal home health agency regulations and compliance standards and regulations * Must read, write and speak fluent English. * HomeCare HomeBase (EMR) experience preferred * A valid driver's license, auto insurance, and reliable transportation are required. Pay Range * $45.00 - $63.00 - pay per visit/unit * $70,500 - $96,900 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. $70,500 - $96,900 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 customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information and identifies opportunities to improve our member and provider experiences. **KNOWLEDGE/SKILLS/ABILITIES** + Manages member services operations. + Ensures compliance with state and regulatory requirements. + Identifies new opportunities for process development. + Develops and implements interventions to address deficiencies and negative trends. + Provides exemplary customer service to customers including members, co-workers, vendors, providers, government agencies, business partners, and the general public. + Work with coworkers, management, and other departments to help coordinate problem solving in an effective and timely manner. + Provide technical expertise to co-workers and handles elevated calls + Provide exemplary customer service to customers including members, co-workers, vendors, providers, government agencies, business partners, and general public + Assists agents with questions and escalated calls. Recognizes trends and patterns in call types and engages leadership with suggested solutions. + Achieves individual performance goals as it relates to call center objectives. + Assists with training needs of employees as needed. + Demonstrates personal responsibility and accountability by meeting attendance and schedule adherence expectations. **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: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.