Molina Healthcare jobs in Houston, TX - 1722 jobs

The Lead, Risk Adjustment - Predictive Analytics role supports Molina's Risk Adjustment Predictive Analytics team. Designs and develops Suspect, Targeting, and Tracking System to support Molina's Prospective and Retrospective Interventions. Provides technical, functional and business training to other team members to enable them to perform the tasks required. Knowledge/Skills/Abilities * Assist Risk Adjustment Data Analytics Leaders in Prospective and Retrospective Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions. * Design and development ad-hoc as well as automated analytical modules related to Risk Adjustment for Medicaid, Marketplace and Medicare/MMP. * Assist Risk Adjustment Data Analytics Leaders in designing and developing Automated Suspect and Target/Ranking Engine for all line of businesses. * Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and related financial data like risk score, revenue and cost. * Conduct root cause analysis for business data issues, report to leadership the summary of findings and resolutions. * Design and lead development of tracking system for risk scores for all intervention outcome and for overall markets and LOB. * Work in an agile business environment to derive meaningful information out of complex as well as large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis. * Work directly with interdepartmental / intradepartmental stakeholders along with Molina Executives to establish/deliver/explain the business requirement as well as data/data points and do necessary escalation as required. * Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors. * 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. * Act as a subject matter expertise by following CMS/State regulations related to Risk adjustment Analytics and provide training as required. Stay current with industry regulation changes and educate the team and management as necessary. * Track, Facilitate and Manage changes in the Datawarehouse platform and perform transparent upgrades to analytics reporting modules to ensure no impact to the end users. * Conduct preliminary and post impact analyses for any logic and source code changes for data analytics and reporting module keeping other variables as constant that are not of focus. * Develop training modules to help analysts understand processes, solutions or designs to meet the customer request for new/existing staff. * Provide technical, functional and business training to other team members to enable them to perform the tasks required. * Maintain a team culture to adopt fast faced agile environment and foster a positive attitude to take on challenging and time sensitive projects. * Take accountability of tasks and projects assigned. Job Qualifications Required Education Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline. Required Experience * 6+ 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, SSIS and SSRS. * Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage. * 5+ Years of experience in Analysis related to Risk Scores, Encounter Submissions, Payment Models for at least one line of business among Medicaid, Marketplace and Medicare/MMP. * 5+ Years of experience in Prospective/Retrospective/Audit targeting Analytics and Reporting. * 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 medical costs to provide analytic support for finance, pricing and actuarial functions 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. Pay Range: $80,412 - $188,164 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Introduction Do you have the career opportunities as a Registered Nurse Manager Emergency Room you want in your current role? We invest in what matters most to nurses like you - at home, at work, and at every stage in your career. We have an exciting opportunity for you to join HCA Houston Healthcare Kingwood which is a part of the nation's leading provider of healthcare services, HCA Healthcare. Do you want to work where you have a voice? Nurses are at the forefront of our commitment to the care and improvement of human life. At HCA Healthcare, there are many ways for nurses to have a voice through professional practice councils, advisory councils, vital voices surveys, and units of distinction. We learn from our multi-generational nursing family. We partner with our Nurses at HCA Houston Healthcare Kingwood! Job Summary and Qualifications We are seeking a Manager of Freestanding Emergency Room for our facility to ensure that we continue to provide all patients with high quality, efficient care. We are an amazing team that works hard to support each other and we are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply now! What You Will Do In Your Role: * You will initiate, guide, and direct the coordination of all functions for the Emergency Room. * You will function as a resource person for staff members and assist in necessary education of individual members of the nursing staff. * You will assume responsibility for the overall quality of nursing care provided in the Emergency Room. * You will make decisions regarding activities within the department based on Hospital Administrative Standards, Human Resource Standards, and Department of Nursing Standards in collaboration with the Director in unusual situations. What qualifications you will need: * 3 years of clinical experience required. * 1 year of leadership experience preferred. * Graduate of an accredited school of professional nursing is required. * Bachelor's Degree in Nursing required. * Current Registered Nurse License in the State of Texas or Multi-State Compact License (Employees with RN Compact License are required to obtain Texas RN License within 90 days of hire date) * Current American Heart Association BLS/ACLS Certification is required. * TNCC and PALS required. Benefits HCA Houston Healthcare Kingwood, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services Wellbeing support, including free counseling and referral services Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. "Nurses play a pivotal role and are the backbone of healthcare delivery. At HCA Healthcare, we are dedicated to ensuring nurses have necessary tools and resources to provide world-class patient care, advocating for the profession and helping to shape the future of nursing." Sammie Mosier, DHA, MA, BSN, NE-BC Senior Vice President and Chief Nursing Executive, HCA Healthcare As a full-service, 420+ bed acute care hospital, HCA Houston Healthcare Kingwood has provided the northeast Houston community with high-quality, cost-effective healthcare for over 25 years. We are dedicated to providing comprehensive, quality care, close to home. Our Women's Center offers high-risk OB care, a Level III NICU, and pediatric services. We have an advanced Brain & Spine Center, which includes a DNV Comprehensive Stroke Center and the Sleep Center of Excellence. Our Orthopedic Center offers total joint replacement surgery using advanced technology. Other services include innovative and customized cardiovascular services, including open heart and vascular surgery and state-of-the-art imaging and endoscopy services for more accurate diagnosis and treatment plans. We are also a Certified Level I Stroke Center and an Accredited Chest Pain Center. We are members of HCA Houston Healthcare, the most comprehensive family of hospitals in the region and part of the leading provider of healthcare in the country, HCA Healthcare. Together we are stronger, smarter and more accessible in providing the patient-centered care you need close to home. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. If this opportunity is your next step in your career path, we encourage you to apply for our Registered Nurse Manager Emergency Room opening. We review all applications. Qualified candidates will be contacted by a member of our team. We are interviewing apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Introduction Do you want to be appreciated daily? Our nurses are celebrated for being on the front line, empathetic for patients. At HCA Houston Healthcare Kingwood our nurses set us apart from any other healthcare provider. We are seeking a(an) Registered Nurse RN ICU to join our healthcare family. Benefits HCA Houston Healthcare Kingwood, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Free counseling services and resources for emotional, physical and financial wellbeing 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) Employee Stock Purchase Plan with 10% off HCA Healthcare stock Family support through fertility and family building benefits with Progyny and adoption assistance. Referral services for child, elder and pet care, home and auto repair, event planning and more Consumer discounts through Abenity and Consumer Discounts Retirement readiness, rollover assistance services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. At HCA Houston Healthcare Kingwood, our nurses play a vital part. We know that every nurse's path and purpose is unique. Do you want to create your own personal career path in nursing? HCA Healthcare is your career destination! Our scale makes it possible for nurses to create the career path that fits their life - for life - and empowers their passion for patient care. Apply today for our Registered Nurse RN ICU opportunity. Job Summary and Qualifications The registered nurse is responsible for coordinating the nursing care of assigned patients in the Unit in order to provide quality patient care to patients in applicable age specific populations (see addendum). The RN applies knowledge of the principles of growth and development. Employee is responsible for knowledge and skill necessary to provide care based on physical, psychological, educational, safety and related criteria for the appropriate age populations. According to established facility policies and procedures, the registered nurse provides and supplies professional nursing care exercising independent judgment in utilizing the nursing process to assess, plan, implement, and evaluate. The RN provides leadership by working cooperatively with ancillary nursing and other patient care team personnel in maintaining standards for professional nursing practice in the clinical setting. Actual duties and responsibilities may vary depending on assigned area. This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned. Kingwood Medical Center reserves the right to revise job duties and responsibilities as the need arises. What you will do in this role: Consistently provides outstanding service to all patients, physicians, fellow employees, and guests. Displays initiative to see processes through to completion and offers assistance without being asked. Maintains awareness of own limitations and seeks guidance from appropriate personnel as needed. Prioritizes activities of self based on demands for service. Remains alert to the detection of errors in own work and the work of others with appropriate corrective actions initiated. Demonstrates an understanding of patient rights, including those pertaining to confidentiality, informed decision-making, and privacy. Is aware of the resources available to patients, significant others and physicians for ethical concerns and makes the appropriate referrals when necessary. Practices cost-efficiency. Performs technical skills proficiently in accordance with established standards, as evidenced by annual validation processes. Utilizes specialized knowledge and skill to proficiently assess, plan, implement, evaluate and document the care of assigned patient. Adheres to Tardiness/Attendance Policy Maintains the standards of nursing care and implements the policies and procedures of the hospital and Nursing Service Division. Assesses the patients condition and nursing needs utilizing the nursing process. Provides, directs and evaluates nursing care provided to patients and reports pertinent observations and reactions of patients to physicians and Charge Nurse. Assesses the need for advanced directive information and makes the information available if applicable. Provides appropriate patient and/or family education or training based on assessed needs. Demonstrates knowledge and skills necessary to assist/provide services to patients in relation to growth and development over the life span, including the ability to assist in the identification of requirements relative to age-specific needs. Utilizes appropriate safety precautions and principles of good body mechanics in the provision of direct patient care services. Demonstrates an ability to operate all applicable equipment and reports malfunctioning equipment appropriately. Demonstrates an ability to perform in an accurate and precise manner in crisis and emergency situations when time is essential. Communicates effectively with patients, physicians, hospital personnel, and others to fulfill position responsibilities. Actively participates in hospital and departmental group meetings. Consistently responds to requests in a positive, professional, and timely manner. Consistently demonstrates behavior which reflects that working as a team is more important than self-interest. Demonstrates interpersonal competencies such as effective problem-solving, negotiation, and conflict management skills. Consistently maintains a professional level of conduct. Facilitates communication with patients, physicians, guests, and coworkers. Consistently demonstrates courteous and positive behaviors, e.g. smile, pleasant tone of voice, positive eye contact. Utilizes appropriate lines of accountability for the continuous improvement of quality. Ensures that problems/concerns regarding departmental activities are communicated with Charge Nurse, Unit Manager, and/or Director. Ensures that problems/concerns regarding activities in the hospital are communicated appropriately. Protects confidentiality of patients/coworkers, respecting their dignity, privacy, and differences. Shows respect for hospital property and the property of others. Communicates and collaborates with peers in Nursing as well as other disciplines and physicians. Facilitates the effective delivery of competent, compassionate care by assisting, in monitoring and evaluating the patient care process and outcomes. Establishes and maintains interpersonal relationships with patients, visitors and other hospital personnel, while assuring confidentiality of patient information. Coordinates services as based on individual patient needs including but not limited to case management, dietary, pharmacy, cardiopulmonary, laboratory, and radiology. Enhances effective and efficient care delivery and achievement of organizational and divisional goals as evidenced by frequent verbal and written communication. Demonstrates the ability to give and receive report relaying vital information regarding the patient's status. Actively participates in hospital and departmental meetings with a focus on providing input regarding improving the quality of patient care services in the Unit. What qualifications you will need: Graduate from an accredited school of Nursing Bachelor's of Science in Nursing preferred One (1) or more years recent clinical experience as a RN required Advanced Cardiac Life Spt must be obtained within 30 days of employment start date Basic Cardiac Life Support must be obtained within 30 days of employment start date Registered Nurse As afull-service, 420+ bed acute care hospital,HCA Houston Healthcare Kingwoodhas provided the northeast Houston community with high-quality, cost-effective healthcare for over 25 years. We are dedicated to providing comprehensive, quality care, close to home. Our Women's Center offers high-risk OB care, aLevel III NICU, and pediatric services. We have an advanced Brain & Spine Center, which includes a DNV Comprehensive Stroke Center and the Sleep Center of Excellence. Our Orthopedic Center offers total joint replacement surgery using advanced technology. Other services include innovative and customized cardiovascular services, including open heart and vascular surgery and state-of-the-art imaging and endoscopy services for more accurate diagnosis and treatment plans. We are also aCertified Level I Stroke Center and an Accredited Chest Pain Center.We are members of HCA Houston Healthcare, the most comprehensive family of hospitals in the region and part of the leading provider of healthcare in the country, HCA Healthcare. Together we are stronger, smarter and more accessible in providing the patient-centered care you need close to home. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "The great hospitals will always put the patient and the patient's family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder Join a family that cares about every stage in your career! We are interviewing candidates for our Registered Nurse RN ICU opening.Apply today and a member of our Talent Acquisition team will reach out. We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

**JOB DESCRIPTION** **Job Summary** Designs and implements processes and solutions associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and unstructured data from multiple disparate sources. Collaborates across departments and with customers to define requirements and understand business problems. Uses advanced mathematical, statistical, querying, and reporting methods to develop solutions. Develops information tools, algorithms, dashboards, and queries to monitor and improve business performance. Creates solutions from initial concept to fully tested production, and communicates results to a broad range of audiences. Effectively uses current and emerging technologies. **KNOWLEDGE/SKILLS/ABILITIES** + Extracts and compiles various sources of information and large data sets from various systems to identify and analyze outliers. + Sets up process for monitoring, tracking, and trending department data. + Prepares any state mandated reports and analysis. + Works with internal, external and enterprise clients as needed to research, develop, and document new standard reports or processes. + Implements and uses the analytics software and systems to support the departments goals. **JOB QUALIFICATIONS** **Required Education** Associate's Degree or equivalent combination of education and experience **Required Experience** 1-3 years **Preferred Education** Bachelor's Degree or equivalent combination of education and experience **Preferred Experience** 3-5 years To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,168 - $116,835 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides 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. **Shift Available:** **12:30-9 PM MST** **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: $16.63 - $24.02 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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: $80,168 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. **Knowledge/Skills/Abilities** + Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. + This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. + Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. + Assists in the reviews of state or federal complaints related to claims. + Supports the other team members with several internal departments to determine appropriate resolution of issues. + Researches tracers, adjustments, and re-submissions of claims. + Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. + Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. + Handles special projects as assigned. + Other duties as assigned. Knowledgeable in systems utilized: + QNXT + Pega + Verint + Kronos + Microsoft Teams + Video Conferencing + Others as required by line of business or state **Job Function** Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. **Job Qualifications** **REQUIRED EDUCATION:** Associate's Degree or equivalent combination of education and experience; **REQUIRED EXPERIENCE:** 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry **PREFERRED EDUCATION:** Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE:** 4 years **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or 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. Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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

Primarily leads compliance training and communications initiatives by developing and managing mandatory education programs, awareness campaigns, and internal communications to promote regulatory adherence and a culture of integrity across the organization. Provides support to Molina functional areas through program management, including policy, workflow and process documentation, management of program controls, vendor practices, budgets, governance frameworks, playbooks and best practices, and champion networks, as applicable. ESSENTIAL JOB DUTIES: * Develops and manages compliance learning programs including mandatory training, awareness campaigns, and communications aligned with regulatory and corporate standards. * Creates and delivers engaging training content using adult learning principles, LMS administration, and data-driven strategies to improve effectiveness. * Oversees compliance communications such as newsletters, intranet content, and resource materials to reinforce awareness of our culture of integrity and reduce compliance risk. * Provides subject matter expertise on compliance program management, including policies, workflows, vendor practices, governance frameworks, resource documents, and best practices. * Responsible for ensuring well-documented policies, workflows, program controls, internal and third-party practices, playbooks and best practices for respective program. * Manages program budget, as applicable, supporting project prioritization. * Collaborates with Legal, Compliance, and Information Security to ensure governance standards are upheld. * Tracks performance metrics and ensures value realization from deployed solutions. * Coordinates recurring meetings to support governance framework and decision-making processes, as needed. * At the direction of program (CoE, Shared Service or other functional area) leadership, supports portfolio management and/or initiative-specific change and project management. * Collaborates with key stakeholders to support dissemination and adoption of program guardrails, processes, best practices and other collateral. * Routinely reviews program collateral to ensure current and accurate reflection of business needs. * Identifies opportunities/gaps and provides recommendations on program enhancements to respective leadership team. * Responsible for creating business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations. * Generates and distributes standard reports on schedule. REQUIRED QUALIFICATIONS: * Minimum of a Bachelor's degree or equivalent experience is required (organizational learning & development, preferably in journalism, public relations, communications, marketing, or a similar field). * Relevant work experience in healthcare compliance program operations and risk management; compliance training management highly preferred * Proficient in virtual collaboration tools and compliance program communications; experienced in developing training content using adult learning principles, managing LMS platforms (e.g., Cornerstone), and leveraging authoring tools (e.g., Articulate360) to deliver branded, engaging educational materials and events. * Program and/or Project management experience, or equivalent combination of relevant education and experience. * Operational Process Improvement experience. * Managed Care experience, preferably in a shared service, CoE or matrixed environment. * Experience with Microsoft Project and Visio. * Strong presentation and communication skills. Pay Range: $80,168 - $155,508 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Introduction Do you want to be appreciated daily? Our nurses are celebrated for being on the front line, empathetic for patients. At HCA Houston Healthcare Northwest our nurses set us apart from any other healthcare provider. We are seeking a(an) Registered Nurse IMCU to join our healthcare family. Benefits HCA Houston Healthcare Northwest, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Free counseling services and resources for emotional, physical and financial wellbeing 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) Employee Stock Purchase Plan with 10% off HCA Healthcare stock Family support through fertility and family building benefits with Progyny and adoption assistance. Referral services for child, elder and pet care, home and auto repair, event planning and more Consumer discounts through Abenity and Consumer Discounts Retirement readiness, rollover assistance services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. At HCA Houston Healthcare Northwest, our nurses play a vital part. We know that every nurse's path and purpose is unique. Do you want to create your own personal career path in nursing? HCA Healthcare is your career destination! Our scale makes it possible for nurses to create the career path that fits their life - for life - and empowers their passion for patient care. Apply today for our Registered Nurse IMCU opportunity. Job Summary and Qualifications The Progressive Care Registered Nurse coordinates and delivers high quality, patient-centered care. In collaboration with medical providers, the RN provides pre-operative and post-operative nursing care. The RN serves as an advocate for patients to support an unparalleled patient experience. What you will do in this role: Assess patient condition during admission and during each shift, identifying and reporting any changes in patient status. Perform procedures or other functions as ordered by the medical provider. Document the administration of care in the patient medical record in a timely and thorough manner. Perform the administration of prescribed medications and monitors response. Maintain a knowledge of medications, procedures, and equipment used in the care of cardiac and medical-surgical patients. What qualifications you will need: Advanced Cardiac Life Spt must be obtained within 6 months of employment start date Basic Cardiac Life Support must be obtained within 30 days of employment start date (RN) Registered Nurse Associate Degree, or Bachelors Degree HCA Houston Healthcare Northwest is a 415+ bed acute care hospital that has been serving the north Houston communities for more than 40 years, providing a wide range of medical services including cardiology, maternity care, Level III NICU, pediatrics, bariatrics and neurology. We comprehensively serve our community by employing expert physicians, specialists, nurses and support staff who work together as a unified team to offer a range of diagnostic treatment and support services. From our 24-hour emergency department with Level II Trauma capabilities, to women's services, to cardiology, we are dedicated to improving the health of our community by delivering exceptional, personalized healthcare. We are members of HCA Houston Healthcare, the most comprehensive family of hospitals in the region and part of the leading provider of healthcare in the country, HCA Healthcare. Together we are stronger, smarter and more accessible in providing the patient-centered care you need close to home. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "The great hospitals will always put the patient and the patient's family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder Join a family that cares about every stage in your career! We are interviewing candidates for our Registered Nurse IMCU opening. Apply today and a member of our Talent Acquisition team will reach out. We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Provides lead level analyst support for configuration information management activities. Responsible for accurate and timely implementation and maintenance of critical information on claims databases, synchronizing operational and claims systems data and application of business rules as they apply to each database, validating data to be housed on databases, and ensuing adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. **Essential Job Duties** - Analyzes and interprets data to determine appropriate configuration changes. - Accurately interprets specific state and/or federal benefits, in addition to other business requirements, and converts terms to configuration parameters. - Manages coding, updating and maintaining benefit plans, provider contracts, fee schedules and various system tables in the user interface. - Applies experience and knowledge to research and resolve claim/encounter issues and pended claims, and updates system(s) as necessary. - Loads and maintains contracts, benefit and/or reference table information into the claims payment system and other applicable systems. - Participates in defect resolution for assigned component(s). - Participates in the implementation and conversion of new and existing health plans. - Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. - Assists with development of configuration standards and best practices, and suggests improvement processes to ensure systems are working efficiently and enhance quality. - Creates reporting tools to enhance communication on configuration updates and initiatives. - Negotiates expected configuration information management completion dates with health plans. - Collaborates with internal and external stakeholders to understand business objectives and processes. - Solutions with health plans and corporate functions to ensure all end-to-end business requirements have been documented. - Assists leadership in establishing standards, guidelines, and best practices for the configuration information management team. - Represents as a departmental configuration information management subject matter expert. - Supports various department-wide configuration information management projects. - Provides training and support to new and existing configuration information management team members, including configuration functionality, enhancements and updates - Manages fluctuating volumes of work, and prioritizes work to meet deadlines and needs of the configuration department and user community. **Required Qualifications** + At least 5 years of configuration information management experience maintaining databases, and/or analyst experience within a health care operations setting in a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs, or equivalent combination of relevant education and experience. + Must have Contract configuration experience in Networx. + Experience with QNXT is preferred. + Advanced experience using a claims processing system. + Advanced experienced verifying documentation related to updates/changes within a claims processing system. + Advanced experience validating and confirming information related to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, and other business requirements. + Analytical and critical-thinking skills. + Flexibility to meet changing business requirements, and commitment to high-quality/on-time delivery + High attention to detail. + Effective verbal and written communication skills. + Microsoft Office suite proficiency, including intermediate to advanced Excel abilities (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $80,168 - $155,508 / ANNUAL *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.

Provides senior level audit support for delegation oversight activities. Responsible for ensuring delegates are complaint with the applicable state, federal, contractual requirements, National Committee for Quality Assurance (NCQA), and Molina requirements for the health plan(s) they support. Identifies risk and non-compliance, issues corrective action, and actively manages the corrective action process to completion reducing and managing Molina's risk. **Essential Job Duties** - Leads and performs pre-delegation, annual audits, and ensures all components of audit activities comply with contractual, regulatory, and accreditation requirements. - Conducts detailed and focused audits on delegates' policies, procedures, case files and evidence of ongoing monitoring to ensure quality and cost-effective provision of delegated services. - Engages delegate leadership to educate, collaborate, and/or remediate risks to Molina. - Leverages highly skilled analytical insights and experience to identify delegate systemic issues and risks that impact the business; collaborates with health plans and/or corporate departments and other business owners to actively address and mitigate risk to Molina. - Conducts analysis of audit issues to identify root-causes, develops and issues corrective action plans (CAPs), and documents follow-up to ensure successful remediation. - Prepares, tracks and provides audit finding reports in accordance with departmental requirements. - Prepares, submits and presents audit reports to delegation oversight committees. - Presents audit findings to delegates, and makes recommendations for improvements based on audit results. - Collaborates with delegation oversight leadership to develop and maintain assessment tools. - Makes independent decisions on complex issues and project components. - Serves as subject matter expert on policies, regulations, contractual requirements and delegate contracts for the relevant area. - Remains current on applicable regulatory, contractual and accreditation requirements and standards; interprets regulatory, contractual and accreditation changes and assesses their impact on the relevant area. - Conducts outreach to multiple department heads regarding key performance indicator (KPI) data analysis for quarterly meetings. - Provides training and support to new and existing delegation oversight team members. **Required Qualifications** - At least 3 years of managed care experience, including at least 2 years of delegation oversight auditing experience, or equivalent combination of relevant education and experience. experience. - Ability to work independently or in a team, support multiple projects at once, and perform other duties or special projects as required. - Ability to collaborate cross-functionally across a highly matrixed organization. - Strong attention to detail and organizational skills. - Strong critical-thinking, and problem-solving/analytical abilities. - Strong interpersonal and verbal/written communication skills. - Microsoft Office suite proficiency (including Excel), and ability to learn/navigate new software programs. **Preferred Qualifications** - Certified Credentialing Specialist (CCS), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Certified Clinical Coder (CCD), Certified Medical Audit Specialists (CMAS), Certified Professional in Healthcare Management (CPHM) and/or other health care certification/licensure. If licensed, license must be active and unrestricted in state of practice. 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: $80,168 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for pharmacy technician activities. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Shift: (11 AM-7:30 PM MST or 12:30-9 PM MST) Essential Job Duties * Performs initial receipt and review of non-formulary or prior authorization requests against pharmacy plan approved criteria; requests additional information from providers as needed to properly evaluate requests. * Accurately enters approvals or denials of requests. * Facilitates prior authorization requests within established pharmacy policies and procedures. * Participates in the development/administration of pharmacy programs designed to enhance the utilization of targeted drugs and identification of cost-saving pharmacy practices. * Identifies and reports pharmacy departmental operational issues and resource needs to appropriate leadership. * Assists Molina member services, pharmacies, and health plan providers in resolving member prescription claims, prior authorizations, and pharmacy service access issues. * Articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed. Required Qualifications * At least 2 years pharmacy technician experience, or equivalent combination of relevant education and experience. * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Ability to abide by Molina policies. * Ability to maintain attendance to support required quality and quantity of work. * Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA). * Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers. * Excellent verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software program(s) proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $31.71 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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

Leads and directs team(s) responsible for member outreach and scheduling of member visits across all lines of business and states. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. **Essential Job Duties** + Directs member outreach team operations to ensure successful member engagement and scheduling of member visits. + Implements direction and performance standards to ensure that goals are achieved. + Manages and evaluates performance of various clinical outreach management activities. + Aligns with leadership, to ensure operational goals and objectives for outsourced operations are understood and met. + Ensures services provided to members are compliant with contractual expectations and specific regulatory requirements. + Demonstrates proficiency in execution of procedures, protocols, benefits, and services. + Assists with training of new leaders/employees as needed. + Demonstrates flexibility in meeting changing performance objectives consistent with department objectives. + Develops standardized methods of improving production, quality and efficiency with vendor and internal partners. + Utilizes Genesys and Epic platforms to meet business objectives. + Ensures coverage of all operating hours and the ability to work any business hours, including weekends and some holidays, as needed. + Ensures internal partners receive operational issue support. + Produces solutions to problems or issues before making decisions, calculates risks for authority level and takes decisive actions where necessary - ensuring that guidance or action keeps with policy and procedural standards. + Schedules and reviews project tasks to ensure high quality product is delivered on time and within budget. + Expands employee performance levels and ensures retention of high performing employees. + Accurately projects resource needs to ensure timely hiring and training of staff. + Demonstrates responsibility for vendor development of process improvement requirements, manages communications related to initiatives, and acts as process champion of initiatives. + Develops executive presentations as needed for review of vendor performance. + Engages in training activities and outcomes. + Determines quality measures for success. + Designs standardized protocols, develops policy, and ensures timely implementation. + Ensures monthly auditing occurs with appropriate follow-up. + Facilitates and participates in committees, task forces, work groups, and multidisciplinary teams as needed. + May be required to travel as needed. **Required Qualifications** - At least 8 years health care experience supporting clinical and contact center operational activities, or equivalent combination of relevant education and experience. - At least 3 years health care management/leadership experience. - Experience managing process improvement activities. - Ability to work cross-collaboratively across a highly matrixed organization. - Team building and conflict resolution skills. - Excellent verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** -Registered Nurse (RN). License must be active and unrestricted in state of practice. 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: $97,299 - $189,732 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job SummaryLeads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance. - Functions as a "hands-on" supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services. - Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence. - Trains and supports team members to ensure high-risk, complex members are adequately supported. - Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines. - Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs. - Assists with coordination and reporting of department statistics and ongoing client reports, as assigned. - Local travel may be required (based upon state/contractual requirements). Required Qualifications- At least 5 years health care experience, and at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. r equivalent combination of relevant education and experience. - Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). 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. - Ability to manage conflict and lead through change. - Operational and process improvement experience. - Strong written and verbal communication skills. - Working knowledge of Microsoft Office suite. - Ability to prioritize and manage multiple deadlines. - Excellent organizational, problem-solving and critical-thinking skills. Preferred Qualifications - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. - Medicaid/Medicare population experience. - Clinical experience. - 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: $66,456 - $129,590 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Designs and implements processes and solutions associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and unstructured data from multiple disparate sources. Collaborates across departments and with customers to define requirements and understand business problems. Uses advanced Excel, SQL querying, and reporting methods to develop solutions. Job Duties * Extracts and compiles information from large data sets from various systems to identify and analyze outliers. * Provide quantitative and qualitative data analysis in the reporting of patterns, insights, and trends to decision-makers. * Works with internal, external and enterprise clients as needed to research, develop, and document new standard reports or processes. * Implements and uses analytics software and systems to support department goals. * Tracks trends related to various feeds, with focus on membership, revenue, and commissions. * Identify any deficiencies within the process, strategize and design improvements where possible. Job Qualifications REQUIRED EDUCATION: Associate's degree or equivalent combination of education and experience REQUIRED EXPERIENCE: * 1-3 years related experience * Proficiency in MS SQL queries and database development. * Proficient in MS Office Suite products, key skills in Excel (VLOOKUPs and pivots). * Intermediate proficiency with complex SQL queries, and stored procedures. * Strong critical thinking and attention to detail. * Ability to effectively communicate with technical and non-technical stakeholders. * Strong time management skills to manage simultaneous projects and tasks to meet internal deadlines PREFERRED EDUCATION: Bachelor's degree or equivalent combination of education and experience PREFERRED EXPERIENCE: 2 - 4 years related experience 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. Pay Range: $80,168 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Introduction Do you have the PRN career opportunities as a(an) Nurse Extern - PRN you want with your current employer? We have an exciting opportunity for you to join HCA Houston Healthcare Clear Lake which is part of the nation's leading provider of healthcare services, HCA Healthcare. Benefits HCA Houston Healthcare Clear Lake, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Fertility and family building benefits through Progyny Free counseling services and resources for emotional, physical and financial wellbeing Family support, including adoption assistance, child and elder care resources and consumer discounts 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) Employee Stock Purchase Plan Retirement readiness and rollover services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. Our teams are a committed, caring group of colleagues. Do you want to work as a(an) Nurse Extern - PRN where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise! Job Summary and Qualifications The Nurse Extern delivers high-quality, patient-centered care by performing a variety of delegated basic patient care services related to common nursing functions and activities of daily living. Under the supervision of the registered nurse (RN), the Nurse Extern assists the nursing staff in providing patient care in accordance with the Nurse Extern's skills/training and the needs of the Department and consistently assists the patient care team with maintaining a clean, well-organized, and safe patient care environment. The Nurse Extern is currently enrolled and in good standing in an accredited school of nursing and can perform higher-level procedures once competency is achieved. Qualifications: Currently enrolled in an accredited school of nursing in an Associate or Bachelor Degree program. Completion of Fundamentals of Nursing course required. Basic Cardiac Life Support must be obtained within 30 days of employment start date HCA Houston Healthcare Clear Lake is a 530+ bed hospital where sophisticated, world-class medicine meets the comfort, care and convenience of a community hospital . For more than 40 years, we have proudly been providing high quality, cost-effective, comprehensive healthcare to the Houston Bay Area. We opened our doors in 1972 and now employ 2,000+ staff members and 900+ physicians in a wide range of specialties. Our specialists offer more talent and experience than any other hospital in the region. We are a Level II Trauma Center and the only exclusive heart hospital south of Houston. Our accredited center provides nationally-recognized care in the prevention, diagnosis, treatment and recovery of cardiovascular diseases. HCA Houston Healthcare Clear Lake offers a variety of other services, including Woman Services, Pediatric Care, Breast Diagnostic Center, ACR-accredited Imaging Center, Wound Care Treatment Center featuring Hyperbaric Oxygen Therapy, and much more. We are members of HCA Houston Healthcare, the most comprehensive family of hospitals in the region and part of the leading provider of healthcare in the country, HCA Healthcare. Together we are stronger, smarter and more accessible in providing the patient-centered care you need close to home. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Nurse Extern - PRN opening. We review all applications. Qualified candidates will be contacted for interviews. Unlock the possibilities and apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status