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Molina Healthcare jobs in Miami, FL

- 1456 jobs
  • Director, Clinical Data Acquisition

    Molina Healthcare Inc. 4.4company rating

    Molina Healthcare Inc. job in Miami, FL

    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. 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.
    $107k-250.4k yearly 35d ago
  • Medical Director, Behavioral Health

    Molina Healthcare 4.4company rating

    Molina Healthcare job in Fort Lauderdale, FL

    JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs. • Facilitates behavioral health-related regional medical necessity reviews and cross coverage. • Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses. • Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts. • Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment. • Provides second level behavioral health clinical reviews, peer reviews and appeals. • Supports behavioral health committees for quality compliance. • Implements behavioral health specific clinical practice guidelines and medical necessity review criteria. • Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). • Assists with the recruitment and orientation of new psychiatric medical directors. • Ensures all behavioral health programs and policies are in line with industry standards and best practices. • Assists with new program implementation and supports for health plan in-source behavioral health services. Required Qualifications • At least 3 of relevant experience, including 2 years of medical practice experience in psychiatry/behavioral health, or equivalent combination of relevant education and experience. • Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice. • Board Certification in Psychiatry. • Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. • Ability to work cross-collaboratively within a highly matrixed organization. • Strong organizational and time-management skills. • Ability to multi-task and meet deadlines. • Attention to detail. • Critical-thinking and active listening skills. • Decision-making and problem-solving skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications • Experience with utilization/quality program management. • Managed care experience. • Peer review experience. • Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. #PJHS #LI-AC1 #HTF 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: $186,201.39 - $363,092.71 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $186.2k-363.1k yearly 2d ago
  • Xray Technician

    Healthtrust Workforce Solutions 4.2company rating

    Miami, FL job

    X-Ray Technician (Basic X-Ray Machine Operator - BXMO) - Contract/ Contract to Hire - Miami, Florida New Hires may receive UP TO $3,000 Sign-On Bonus! The MDNow Urgent Care Clinic hours are Monday-Sunday 8am-8pm. Must have the flexibility to work during those hours. Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for our BXMO X-RAY TECH opening with MD Now today and find out what it truly means to be a part of the HCA Healthcare Team. Benefits: MD Now, 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 at no cost or for a low copay Additional options for dental and vision benefits 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 stocks Job Summary and Qualifications: What you will do in this role: As a basic X-Ray Technician, you will be responsible for performing all required radiological and lab duties according to providers orders, clinical practice under state law and in compliance with company policy and procedures. Performs drug screens, urinalysis and other in-house lab tests accurately. Processes specimens for reference laboratories. Maintains, calibrates and performs controls on lab/x-ray equipment daily. Works closely with the Center Manager, Medical Staff, Front Desk Coordinator and all clinic staff to maintain smooth operations and high customer satisfaction. Understands and follows company compliance program policies, procedures and follows all company policies pertaining to infection control, hand hygiene, and all OSHA and company policies pertaining to a safe and secure environment for patients and staff. Keeps the clinical environment clean, orderly and in compliance with company policy and accrediting standards. May be required to work alternate shifts and may be required to float to other clinic locations. You should have: Graduate of an accredited school of Radiological Sciences required. 1+ year of clinical experience in a patient care setting preferred. BMO - Basic X-Ray Machine Operator License in Florida BLS certification within 30 days of start required. Federal Breath Alcohol Screening Certification within 30 days of start. Federal Drug Screening Certification within 30 days of start. Office Laboratory Assistant License if required by the state. Demonstrated excellence in Customer Service. Demonstrated strong written and verbal communication skills. Have a basic knowledge of computers and office machines. MD Now Urgent Care is the largest and fastest growing provider of urgent care in Florida. MD Now Urgent Care's physician-led team of healthcare professionals provides high-quality healthcare through a comprehensive lineup of urgent care and occupational health services during convenient hours. MD Now Urgent Care is owned and operated by HCA Healthcare, one of the nation's leading providers of healthcare services. MD Now Urgent Care is proud to be affiliated with HCA Florida Healthcare, the state's largest provider of healthcare services.
    $56k-76k yearly est. 1d ago
  • Emergency Medicine Physician

    HCA Florida Healthcare 4.5company rating

    Miami, FL job

    HCA Florida Kendall South Dade FSED is seeking FT board certified or board eligible EM Physicians to join this premier practice along the Florida Atlantic Coast in Miami. The FSED is a 10 bed ED that is supported by and transfers to the sister facility at HCA Florida Kendall Hospital, a level 1 trauma center, burn center, cardiac center, and comprehensive stroke center. FSED Features: 10,000 annual patient visits per year 9-bed ED; 1 resuscitation room POC Comprehensive lab on site CT and X-ray onsite US On call 24 hours Physician coverage - 24 hours/day (12 hour shifts) Peds volume - less than 9% EMR - Meditech PDOC Offering occurrence based malpractice insurance with tail coverage Comprehensive benefits package with medical, dental, vision and 401k
    $160k-234k yearly est. 23h ago
  • PA - Academic - 20277154

    HCA Florida Mercy Hospital 4.5company rating

    Miami, FL job

    HCA Florida Mercy Hospital is seeking an Orthopedic Physician Assistant in Miami, Florida. Qualified Candidates: • Experience in Orthopedics • First Assist in Surgery • Spanish speaking is a plus Incentive/Benefit Package: • Competitive compensation • 401K
    $62k-81k yearly est. 60d+ ago
  • Adjudicator, Provider Claims-Ohio-On the Phone

    Molina Healthcare 4.4company rating

    Molina Healthcare job in Miami, FL

    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: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $21.2-38.4 hourly 12d ago
  • Lead Analyst, Quality Analytics and Performance Improvement (HEDIS)

    Molina Healthcare 4.4company rating

    Molina Healthcare job in Miami, FL

    The Lead Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Reporting team. Designs and develops reporting solutions to assist HEDIS Outbound, Inbound extracts, Data Ingestions, Dashboards, Reports & Extracts for rate tracking and other outreach purposes. **ESSENTIAL JOB DUTIES:** -Mentors and leads 2-10 software engineers on multiple projects for project deliverables, assess deliverables' quality, plan and implement corrective and preventive actions to improve application quality. -Evaluates alternative systems solutions and recommends solution that best meets the need of the business. -Develops the BRDs along with business stakeholders, Conceptual Designs for multiple projects concurrently. SOX compliant Project deliveries and Project coordination. -Translates user requirements into overall functional architecture for complex s/w solutions in compliance with industry regulations. -Provides subject matter expertise and reviews applications designs built using .Net Framework 1.1/2.0, C#, VB.NET, ASP.NET, VB6.0, VB Script, Java Script, XML, HTML, DHTML, SharePoint server, BizTalk Server 2004/6, Microsoft SQL Server 2000/5, DTS/SSIS/SSRS on windows platform. -Drives Joint Applications Development session with business stakeholders to define business requirements and provides systems/application expertise for multiple projects concurrently. -Communicates with cross functional teams (and if applicable, vended partners) to coordinate requirements, design and enhancements with the development team(s). -Assesses and analyzes computer system capabilities, work flow and scheduling limitations to determine if requested program or program change is possible within existing system. -Recognizes, identifies and documents potential areas where existing business processes require change, or where new processes need to be developed, and makes recommendations in these areas. -Works independently and resolves complex business problems with no supervision. -Mentors and leads 2-10 systems or programmer analysts on multiple projects for project deliverables, assesses deliverables' quality, plans and implements corrective and preventive actions to improve application quality. -Works with project managers to define work assignments for development team(s). -Identifies, defines and plans software engineering process improvements and verifies compliance. -Mentors and trains systems/programmer analysts on software applications, business domain and design standards. -Conducts peer review of other analysts (internal and contract staff) to ensure standards and quality. -Recommends, schedules and performs software systems/applications improvements and updates. -Conducts studies pertaining to designs of new information systems to meet current and projected needs. -Defines and plans software releases in accordance with other software applications. Assists in the project definition, execution and implementation. Provides application, business process or functional domain leadership/expertise and peer mentoring to IT staff. Provides expertise to one or multiple domain such as application development, business process re-engineering, enterprise integration, logical data modeling, project coordination, estimation, metrics generation, status reporting. Provides thought leadership or hands-on expertise for problem resolution, application enhancements, user training and documentation of business processes. Strong application delivery methodology or SDLC background, functional domain or software engineering expertise or proficiency. Manages small or medium size projects as assigned. -Excellent verbal and written communication skills. -Must be knowledgeable of business processes, industry standard quality norms, systems and applications development best practices, project management methodologies and estimation processes. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline **Required Experience** **-** 5+ years' experience supporting, designing and/or implementing application changes. **Highly Preferred Experience** - 5+ Years of experience in working with **HEDIS** tools such as **Inovalon** or **ClaimSphere** - 5+ Years of experience in working with HEDIS Domain - such as Measure analysis/reconciliation on data w.r.t measure specifications. - 5+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data. - 5+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design - 5+ years of experience in working with **Microsoft T-SQL, Databricks SQL and PowerBI.** - Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage. - Familiarity with Microsoft Azure, AWS or Hadoop. - 3-5 Years of experience with predictive modeling in healthcare quality data. - 5+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among Medicaid, Marketplace and Medicare/MMP. - 5+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. - 5+ Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for quality, finance, and health plan functions - 5 years of experience in working with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,412 - $188,164 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $80.4k-188.2k yearly 60d+ ago
  • CT Technologist FSED Florida City Center

    HCA Florida University Hospital 4.5company rating

    Davie, FL job

    Introduction Do you want to join an organization that invests in you as a(an) CT Technologist FSED Florida City Center? At HCA Florida University Hospital, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. Benefits HCA Florida University Hospital 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. You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated CT Technologist FSED Florida City Center like you to be a part of our team. Job Summary And Qualifications The CT Technologist works in the inpatient and/or outpatient setting performing a variety of CT Scan imaging procedures used to diagnose medical conditions. You will operate the CT scan equipment to produce quality images for detecting pathology and abnormalities in patients. You will obtain consent, prepare patients, and explain the procedure to them. What qualifications you will need: Basic Cardiac Life Support must be obtained within 30 days of employment start date (ARRT-CT) Computed Tomography (ARRT-R) Radiography (RT) Radiologic Technologist/Radiographer Vocational School Graduate HCA Florida University Hospital is a 165 bed hospital. We serve Davie and the surrounding communities in Broward County, FL. We opened in 2021, have 600 colleagues and over 750 physicians. We have a full range of healthcare services. We use technology to deliver great patient experiences. We have a 24/7 emergency department, maternity and orthopedics. We have oncology, neurosciences and diagnostic services. We offer robotic and minimally invasive surgical services. We offer all private patient rooms. We are located next to Nova Southeastern University. 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. "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our CT Technologist FSED Florida City Center opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring! 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.
    $60k-77k yearly est. 2d ago
  • Supervisor, Healthcare Services Operations Support

    Molina Healthcare 4.4company rating

    Molina Healthcare job in Miami, FL

    JOB DESCRIPTION Job SummaryLeads and supervises a team supporting non-clinical healthcare services activities for care management, care review, utilization management, transitions of care, behavioral health, long-term services and supports (LTSS), and/or other program specific service support - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Supervises healthcare services operations support team members within Molina's clinical/healthcare services function, which may include care review, care management, and/or correspondence processing, etc. - Researches and analyzes the workflow of the department, and offers suggestions for improvement and/or changes to leadership; assists with the implementation of changes. - Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance. - Provides regular verbal and written feedback to staff regarding performance and opportunities for improvement. - Assists in the development and implementation of internal desktop processes and procedures. - Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers. Required Qualifications- At least 5 years of operations or administrative experience in health care, preferably within a managed care setting, or equivalent combination of relevant education and experience. - Strong analytic and problem-solving abilities. - Strong organizational and time-management skills. - Ability to multi-task and meet project deadlines. - Attention to detail. - Ability to build relationships and collaborate cross-functionally. - Excellent verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Supervisory/leadership experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $77,969 - $106,214 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $78k-106.2k yearly 38d ago
  • Associate Specialist, Provider Contracts HP

    Molina Healthcare 4.4company rating

    Molina Healthcare job in Miami, FL

    Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when available, and the 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. **Job Duties** This role supports negotiations with assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures. - Sends out contracts/applications to prospective providers upon request of Director or Manager and/or Provider Contracting and/or Provider Relations team members. - Receives calls from prospective providers and answers questions regarding contracting process, policies and procedures. - Forwards requested information/documentation to prospective providers in a timely manner. - Maintains database of all contracts and specific applications sent to prospective new providers. - Completes and updates Provider Information Forms for each new contract. - Ensures accuracy and completeness of provider demographic information and coordinates communication of such information to Provider Configuration team. - Sends out new provider welcome packets to providers who have contracted with the plan. - Utilizes Plan's system to track and follow up with Providers who have not responded to Contracts and/or Applications sent as directed by management. - Formats and distributes Provider network resources (e.g. electronic specialist directory). **Job Qualifications** **REQUIRED EDUCATION** : High School Diploma or equivalent GED **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : 1 year customer service, provider service, contracting or claims experience in the healthcare industry. **PREFERRED EDUCATION** : Associate's Degree or Bachelor's Degree in a related field or an equivalent combination of education and experience **PREFERRED EXPERIENCE** : Managed Care experience To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $42.2 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $21.2-42.2 hourly 7d ago
  • Pathologists Assistant

    HCA 4.5company rating

    Fort Lauderdale, FL job

    Introduction Do you want to join an organization that invests in you as a Pathologists Assistant? At HCA Healthcare, you come first. HCA Healthcare has committed up to 300 million in programs to support our incredible team members over the course of three years. Benefits HCA Healthcare 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. You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated Pathologists Assistant like you to be a part of our team. Job Summary and Qualifications DUTIES INCLUDED BUT NOT LIMITED TO: * Responsible for the organization of and efficiency of workflow processes in the frozen section and gross examination areas. * Work closely with on-site Pathologists in determining grossing priorities. * Take instruction from on-site Pathologists with respect to grossing technique and quality assessment. * Confer with and share with other HCA pathologist assistant's relevant information that would facilitate productivity and expand knowledge base. * Triage specimen received from surgery; dictate gross findings on selected specimen using appropriate terminology; refer tissue sections for microscopic review by Pathologist or Resident. * Select and identify tissue for microscopic study; determine proper fixative solutions in which tissue will be maintained. * Perform specialized procedures such as frozen sections and decalcification; maintain and coordinate specimen and records for specialized procedures using appropriate protocols; submit request for special histological procedures and special stains when appropriate. * Maintain records of surgical pathology specimen dissections and dictation; assist in the compilation of reports for surgical pathology; label and store gross tissue specimen. * Photograph specimen samples as appropriate for use in instruction and documentation. Perform photo microscopy on cases considered for interdepartmental conferences or for teaching purposes; maintain complete and accurate records of all gross and microscopic photographs. * Perform other related duties incidental to the work described herein. * Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement". Last Update: February 2020 EDUCATION: * Bachelor's degree required; * Masters preferred. EXPERIENCE: * Minimum three to five years' experience in a pathology histology laboratory setting. CERTIFICATION/LICENSE * Certification by the American Society of Clinical Pathologists preferred * 3-5 years grossing experience in a hospital setting accepted in lieu of ASCP Certification or Master's degree Physician Services Group is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcares graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcares commitment to the care and improvement of human life. HCA Healthcare has been recognized as one of the Worlds 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. "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Pathologists Assistant opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring! 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.
    $54k-90k yearly est. 60d+ ago
  • Manager, Threat & Crisis Intelligence

    Molina Healthcare 4.4company rating

    Molina Healthcare job in Miami, FL

    As the Manager, Protection Services Operations Center (PSOC), you will be a member of Molina Healthcare's Protection Services Operations Center, reporting to the Director. This role is crisis and threat intelligence focused and includes responsibilities for ensuring the execution of the physical security controls, threat/risk analytics, and incident intake and crisis management support for the enterprise. This role drives and manages physical security, incident response and safety operations for Molina facilities and employees in the field. The manager leads the in-house security operations team and coordinates the contract security assets; utilizes video surveillance platforms, access control, visitor management, alarm systems and threat intelligence platforms; safeguarding Molina employees, vendors and visitors, as well as equipment and facilities. This position also oversees Protection Services Operations (PSOC) projects, programs and deliverables to ensure compliance with all regulatory requirements. The manager will assume the role and responsibilities of the next level in the chain of command in their absence. This role will liaise with all enterprise leaders and stakeholders to address security issues or incidents that arise in the field or Molina offices. Activities will ensure alignment with policies, standard and procedures in deliverables. Additionally, this person will support incident response and crisis management activities during disruptive events as needed. **Knowledge/Skills/Abilities** + Manage and oversee consultants and senior consultants to ensure delivery of day-to-day operational and response activities. Monitor incident, intake and work queues to ensure organizational SLAs are meet for enterprise + Act as liaison to business stakeholders and third-parties for developing and implementing operational physical security, threat/risk analytics and incident management programs supporting day-to-day services for Molina business operations + Guide and oversee development of new services to increase effectiveness, and to eliminate or control high risk or unsafe practices, operations and conditions. This person will be responsible for the implementation, delivery, ownership and operations of the PSOC team's policies, standards, procedures and systems + Aligns strategy to meet stakeholder needs and requirements across multiple business units. Recommend, shape and deliver a continuously improving security culture, serving as a thought leader and trusted advisor. Educate and influence on matters involving the promotion of a proactive risk management culture + Leads supplier relationships and services agreements relevant to PSOC operations and technology providers + In partnership with stakeholders, develop annual training and awareness schedule to ensure delivery of ongoing security and safety training for employees and contractors + Model, assess and trend multiple intelligence sources to identify risks and threats to employees, assets, and executives. Identify risks & threats and inform key stakeholders of the threat and the recommended actions for mitigation + Deliver reports, briefings, and presentations on research findings and provide the necessary recommendations + Conduct, and assist, with risk assessments in advance of major company events, employee and executive travel, and in support of major business decisions + Engage in training and outreach to all Affirmers about personal safety and security while travelling domestically and abroad + Ensure appropriate consultation regarding threat mitigation, workplace violence, and regulatory compliance. Regularly report compliance metrics to senior leadership ensuring trends and threats are identified with recommendations for mitigation + Prepares and manages operational budget including forecasting, staffing and third-party expense management + May be required to work outside of normal business hours (nights, evenings, and weekends) if responding to emergencies + Perform other duties as assigned + Up to 10% travel **Job Qualifications** **Required Education:** + Bachelor's degree **Required Experience:** + Minimum 8 years demonstrated leadership in programs at a national or enterprise level + Minimum 5 years' experience with access control, alarm, and threat intelligence platforms including Lenel, Avigilon, Envoy and Everbridge + Minimum 5 years' experience with project management, including implementation/project management of physical security solutions in facilities + Minimum 3 years' experience managing in a matrixed environment + Large scale security operations in a multinational company environment. Worked across functions in a matrixed organization, commensurate with a Fortune 500 **Required Licensure or Certification:** + Nationally recognized physical security certification, and/or FEMA or Department of Homeland Security certifications **Required Knowledge, Skills and Abilities:** You are + Knowledge and ability to think creatively, proactively, and independently + Able to lead, communicate and influence at all management levels and thrive in a cross-functional matrix environment + Able to effectively facilitate meetings, prepare reports and presentations, and manage data + Self-motivated and results oriented. A problem solver. An analytical thinker + Comfortable and capable of developing/presenting data-driven solutions and recommendations + Superb organizational skills and the ability to delegate effectively to meet delivery targets + Able to interact concisely/accurately and positively with stakeholders. Remain calm in challenging business situations + Innately know how to 'get it done' including engaging/motivating others to deliver results. You plan workloads and deliver on commitments + Able to quickly build rapport and gain the respect and cooperation of both technology and business leaders. Possess strong interpersonal and indirect influencing skills, with a demonstrated ability to gain the confidence of individuals at various organizational levels + Someone that thrives in ambiguity and make quality decisions in a dynamic, fast paced environment + Action oriented and driven to achieve results in a positive manner, displaying ethical behavior, integrity, and building trust at all times You have a deep understanding of: + The candidate should have a strong grasp of: + The full spectrum of security operations services: + Access control administration and management + Alarm-intrusion response + Visitor management + Threat analytics + Incident intake and coordination + Investigation support + Security queue and workflow management + Policies, standards and procedures + Metrics, reporting and analysis + Extensive experience with Lenel OnGuard, Avigilon surveillance, Everbridge (including VCC, Notification and SafetyConnect). Envoy experience preferred + Software skills & competencies are required, as well as internet research abilities and strong communication skills. Includes: MS Office (Outlook, Word, Excel, and PowerPoint) and also preferably a familiarity with SharePoint and Visio + Excellent knowledge of security operations best practices, policies, and procedures + Extensive knowledge of project management + Familiarity with industry standards, including ISO 22301, HIPPA, PCI, IOSCO, CMS and Department of Homeland Security guidance 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.
    $36k-76k yearly est. 35d ago
  • Microbiology Technologist

    HCA 4.5company rating

    Deerfield Beach, FL job

    Introduction Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Microbiology Technologist with HCA Healthcare Laboratory Services you can be a part of an organization that is devoted to giving back! Benefits HCA Healthcare Laboratory Services 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. Would you like to unlock your potential with a leading healthcare provider dedicated to the growth and development of our colleagues? Join the HCA Healthcare Laboratory Services family! We will give you the tools and resources you need to succeed in our organization. We are looking for an enthusiastic Microbiology Technologist to help us reach our goals. Unlock your potential! Job Summary and Qualifications Seeking a hospital-based Microbiology Technologist to provide expertise and champion results. We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels the patient experience is as meaningful as we do. You Will: * Perform stat and routine microbiology and/or serology testing * Apply theoretical concepts of laboratory medicine using independent judgement to ensure timely and accurate results * Perform non-technical duties including, but not limited to specimen receipt, processing, storage, retrieval and submission of samples for referral testing as required * Support the department in achieving department goals for service, quality, regulatory compliance, financial performance, patient satisfaction, healthy work environment, and integration of intra and inter-departmental activities You Should Have: * A 2 Year/Associate's Degree in a science * A 4 Year/Bachelor's Degree in Medical Technology is preferred * A State of Florida Technologist License is required OR the ability to obtain a license during the interview process * Technical specialty in Microbiology with additional experience in Serology/Immunology preferred * 2 years' experience in a clinical laboratory setting is helpful HCA Healthcare Laboratory Services is a full-service provider of clinical laboratory and anatomic pathology services, providing hospitals, physicians, and clients with timely diagnostic information for patient care. Our infrastructure includes a fully automated esoteric core laboratory in Fort Lauderdale, a histology and microbiology operation in Largo, Florida, and a network of hospital-based rapid-response laboratories present in four HCA Healthcare divisions in Florida. Our core laboratories support more than 250 acute and rehab hospitals, physician practices, surgery centers, and commercial accounts. 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 costs for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder Be a part of an organization that invests in you! We are reviewing applications for our Microbiology Technologist opening. Qualified candidates will be contacted for interviews. Submit your application and help us raise the bar in patient care! 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.
    $48k-62k yearly est. 47d ago
  • Program Manager (Dual Eligible Outreach)

    Molina Healthcare 4.4company rating

    Molina Healthcare job in Miami, FL

    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. **Job Duties** + Active collaborator with 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. + Focuses on process improvement, organizational change management, program management and other processes relative to the business. + Leads and manages team in planning and executing business programs. + Serves as the subject matter expert in the functional area and leads programs to meet critical needs. + Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed. + Works with operational leaders within the business to provide recommendations on opportunities for process improvements. + 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 Program and/or Project management experience. + Operational Process Improvement experience. + Healthcare 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 Program and/or Project management experience. - Managed Care experience. - Experience working in a cross functional highly matrixed organization. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : - PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification and/or comparable coursework desired. 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.
    $78k-155.5k yearly 11d ago
  • Associate Analyst, Clinical Informatics (Bilingual in Spanish Required) - Monday - Friday 7AM - 4PM PST (REMOTE)

    Molina Healthcare 4.4company rating

    Molina Healthcare job in Miami, FL

    Provides entry level analyst support for clinical information systems activities. Responsible for provision of application technical support and design for clinical information systems - ensuring creation of workflows and enhancements that support process improvement and change management initiatives. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Assists in the development and support of clinical, practice management and operational workflows. - Assists in the design of workflow analysis, device integration, planning and implementation of clinical systems. - Participates in the system implementation life cycle including: planning, implementation, training, and post-implementation support. - Assists in issue resolution related to the clinical information system. Required Qualifications - At least 1 year of system implementation experience, or equivalent combination of relevant education and experience. - Knowledge of systems design methods and techniques. - Knowledge base in health care informatics. - Ability to work independently, within a team and collaboratively across teams. - Analysis, synthesis and problem-solving skills. - Attention to detail and accuracy. - Multi-tasking, planning, and workload prioritization skills. - Verbal and written communication skills. - Microsoft Office suite/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 - $42.2 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $21.2-42.2 hourly 34d ago
  • Cardiac Cath Lab Admin

    HCA Healthcare 4.5company rating

    Margate, FL job

    **Introduction** Do you want to join an organization that invests in you as a(an) Cardiac Cath Lab Admin? At HCA Florida Northwest Hospital, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. **Benefits** HCA Florida Northwest Hospital 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._** You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated Cardiac Cath Lab Admin like you to be a part of our team. **Job Summary and Qualifications** **What qualifications you will need:** + High School Graduate / GED + Strong leadership and management skills. + Excellent communication and teamwork skills. + Proficiency in data management and record-keeping. + Knowledge of cath lab procedures and equipment. + Conflict resolution and decision-making abilities. HCA Florida Northwest Hospital is a 289-bed medical center. Incorporating the latest technology in healthcare drives our results. We have been granted the Gold Seal of Approval from the Joint Commission. This proves our commitment to high performance and level of service. We are certified by the Joint Commission as a primary stroke center. We uphold the highest standards in patient care. We also remain an accredited chest pain center by the American College of Cardiology. We handle patients with care and urgency. We are proudly known as a Comprehensive Bariatric Center of Excellence. Our accolades speak for themselves. We continue growing to meet the needs of the community we serve. We have expanded capabilities in emergency and critical care. Our services go above and beyond. Additional growth includes women's and children's services. We hold the only Level III NICU in northern Broward County. The breadth of our service lines translates to better patient care. This means increased professional opportunities for our colleagues. Join a dynamic team of dedicated healthcare professionals. Explore your growth potential. 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. "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Cardiac Cath Lab Admin opening. Qualified candidates will be contacted for interviews. **Submit your resume today to join our community of caring!** 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.
    $77k-93k yearly est. 11d ago
  • Care Review Clinician (RN)

    Molina Healthcare 4.4company rating

    Molina Healthcare job in Miami, FL

    Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes clinical service requests from members or providers against evidence based clinical guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. • Processes requests within required timelines. • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote the Molina care model. • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified Professional in Healthcare Management (CPHM). • Recent hospital experience in an intensive care unit (ICU) or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. MULTI STATE / COMPACT LICENSURE Individual state licensures which are not part of the compact states are required for: CA, NV, IL, NY and MI WORK SCHEDULE: Tues - Sat shift will rotate with some holidays. Training will be held Mon - Fri 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: $26.41 - $61.79 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $26.4-61.8 hourly 2d ago
  • Collections Specialist CBO

    HCA Healthcare 4.5company rating

    Miramar, FL job

    **Introduction** Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for the opportunity below:Collections Specialist at the East Florida Central Billing Office **Benefits** Surgery Ventures 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._** As the Collections Specialist, you will contribute to the company's mission, vision, and values by completing follow-up and collections for patient services. Under the supervision of the Business Office Manager/Business Office Supervisor, you will obtain payment from third party payers and self-pay accounts to enhance cash flow and gather reimbursement based on established contracts. **What you will do in this role:** + You will perform follow up activities on accounts to ensure prompt payment + You will identify coding or billing errors from EOBs and work to correct them + You will monitor insurance claims and contact insurance companies to resolve claims + You will update the patient account record to identify actions taken + You will assign bad debt accounts to the collection agency + You will act as a liaison and administer contracts in collection of third party accounts (Medicare and Medicaid) + You will complete account reconciliation of accounts turned over to outside agencies + You will negotiate payment plans on self-pay accounts + You are responsible for maintaining accounts receivable and creating a reduction in bad debt **Qualifications you will need:** + Minimum (1) year of experience in a medical office setting highly preferred. (i.e. ambulatory surgery center, hospital, doctors office) preferred + Knowledge of managed care payers and medical terminology is preferred Consider a fulfilling and secure career with Surgery Ventures, in partnership with HCA Healthcare. Our team of over 3,400 physicians manages more than 150 surgery centers across 16 states in the United States. As a dedicated unit within HCA Healthcare, we prioritize providing safe, efficient, and premium surgical services. With over 30 years of pioneering experience in the industry, our physician partners offer exceptional outpatient care to over 800,000 patients in communities across our network. We do so with the backing of the clinical, operational, and financial expertise of a Fortune 100 healthcare leader. At Surgery Ventures, we are committed to supporting your career growth and advancement at every stage. 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 "There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you find this opportunity compelling, we encourage you to apply for our Collections Specialist CBO opening. We promptly review all applications. Highly qualified candidates will be directly 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.
    $29k-38k yearly est. 4d ago
  • Corporate Development Manager

    Molina Healthcare 4.4company rating

    Molina Healthcare job in Miami, FL

    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.
    $80.4k-156.8k yearly 60d+ ago
  • EEG Technician Per Diem Rotate

    Tenet Healthcare 4.5company rating

    Delray Beach, FL job

    Performs standard and complex electroencephalographic recordings under minimum direction. This position is responsible for obtaining standard, cerebral silence, STAT and outpatient EEG recordings the position is also responsible for monitoring additional physiological phenomena by means of appropriate techniques. EDUCATION: Minimum: High School or Equivalent Preferred: Associates degree in physical or biological science. EXPERIENCE: Prefer One (1) year previous hospital experience. REQUIRED CERTIFICATION/LICENSURE/REGISTRATION: BLS certification required, REEGT preferred. #LI-RR1 Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
    $63k-98k yearly est. Auto-Apply 43d ago

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