Medical Director, Behavioral Health
Molina Healthcare job in Tacoma, WA
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
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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.
Director, Clinical Data Acquisition
Molina Healthcare job in Tacoma, WA
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.
Strategy Advancement Advisor - Distribution Strategy
Olympia, WA job
**Become a part of our caring community and help us put health first** With over 10 million sales interactions annually, Humana understands that while great products are important, it's the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does.
The Strategy Advancement Advisor provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for business segments or the company at large. The Strategy Advancement Advisor works on problems of diverse scope and complexity ranging from moderate to substantial.
**Become a part of our caring community and help us put health first**
The Strategy Advisor (Distribution) provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for the Enterprise Growth vertical. The Strategy Advisor's work involves complex assignments performed without direction where the analysis of situations or data requires an in-depth evaluation of variable factors. This work may require leading end-to-end strategy engagements.
As part of the Strategy Advancement team, this role will support MarketPoint's investment rationalization and strategic planning efforts. The role requires comfort with ambiguity and creating new solutions in the "white space" where answers are not clear cut or readily available. A successful candidate will be someone who has worked for several years in large matrixed organization (e.g. a publicly traded corporation or large not profit organization) or has several years' experience with stakeholder management (strategy/operations at a top-tier consulting/professional services firm). They will have a demonstrated ability to synthesize large amounts of information into clear and concise outputs (PPT, Excel). This person must be comfortable working collaboratively with senior leaders and subject matter experts alike and should have a high degree of executive presence leading engagements with these stakeholders. This person also will be effective at multitasking and possess keen program and change management skills to balance an evolving set of priorities and deadlines. Healthcare experience is a plus, but not required, though must have a history of mastering an understanding of their prior industry.
Other examples of the kind of work required from this role include leading the analysis of complex business problems and issues using data from internal and external sources. The candidate should bring expertise or identify subject matter experts in support of multi-functional efforts to identify, interpret, and produce strategic recommendations and plans. The candidate's work will substantially shape the thinking of distribution org. They will exercise independent judgment and decision making on complex issues to determine the best course of action and work under minimal supervision.
**Use your skills to make an impact**
About the team: Humana's distribution organization, MarketPoint, plays a key part in driving Humana's long-term vision to achieve leading growth in Medicare and individual products. The MarketPoint strategy team was created to help transform Humana's customer acquisition approach. The team functions with a mandate to think creatively, discover new opportunities and re-envision operations to drive growth and deliver a first-class experience to our members and agents.
**Responsibilities:**
+ Leads multiple short- and long-term work streams sometimes across engagements, including hypothesis development, working sessions, and report-outs with leaders across the company, and documenting key ideas and actions to drive follow-up actions
+ Partners closely with finance, analytics, and operators to optimize, track, and report out on internal and external compensation strategy and results
+ Develop high-quality analysis and deliverables that clearly frame organizational objectives, issues/challenges, and articulate compelling, insightful findings, conclusions, and recommendations
+ Lead multiple cross functional investment sizing workstreams and provide high-level support for senior leaders to make informed decisions
+ Identify new growth avenues of opportunity through independent analysis and presents actionable findings
+ Lead key portions of presentations at high-visibility meetings
+ Assist MarketPoint leadership in communicating value and impact of MarketPoint initiatives to broader Humana organization
+ Coach junior team members to develop technical and professional skillsets
**Use your skills to make an impact**
**Required Qualifications**
+ Bachelor's degree
+ **3+ years** of progressive experience consulting in finance, strategic planning, or related roles.
+ Proven track record in **building compensation models** and **incentive design frameworks** .
+ Advanced proficiency in **financial modeling and Excel**
+ Demonstrated experience **managing large, complex budgets** and guiding senior leadership through **trade-off decisions** .
+ Strong background in **business case development** , including **value sizing** , ROI analysis, and scenario modeling.
+ Ability to influence and partner with senior executives to drive strategic decisions.
+ Exceptional analytical and problem-solving skills with a focus on **data-driven decision-making** .
+ Strong communication skills to present complex financial concepts clearly to non-financial stakeholders.
**Preferred Qualifications**
+ Healthcare industry experience, preferably in the managed care or provider sector
+ Experience in **compensation strategy** within large organizations.
+ Exposure to **enterprise-level budgeting and resource allocation** .
**Additional Information**
**- Position does have the potential for up to 5% travel.**
**- Position will be working Eastern (EST) hours.**
**Virtual Pre-Screen**
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a HireVue interview. In this interview, you will listen to a set of interview questions over your phone or text and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
**Work-At-Home Requirements**
At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$115,200 - $158,400 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-28-2025
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
Easy ApplyLead Analyst, Quality Analytics and Performance Improvement (HEDIS)
Molina Healthcare job in Tacoma, WA
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.
Patient Services Coordinator LPN Home Health
Kent, WA job
Become a part of our caring community and help us put health first * $2,500 Sign-on Bonus* The Patient Services Coordinator-LPN is directly responsible for scheduling visits and communicating with field staff, patients, physicians, etc. to maintain proper care coordination and continuity of care. The role also assists with day-to-day office and staff management.
* Manages schedules for all patients. Edits schedule for agents calling in sick, ensuring patients are reassigned timely. Updates agent unavailability in worker console.
* Initiates infection control forms as needed, sends the HRD the completed "Employee Infection Report" to upload in the worker console.
* Serves as back up during the lunch hour and other busy times including receiving calls from the field staff and assisting with weekly case conferences. Refers clinical questions to Branch Director as necessary.
* Maintains the client hospitalization log, including entering coordination notes, and sending electronic log to all office, field, and sales staff.
* Completes requested schedule as task appears on the action screen. Ensures staff are scheduled for skilled nurse/injection visits unless an aide supervisory visit is scheduled in conjunction with the injection visit.
* Completes requested schedules for all add-ons and applicable orders:
* Schedules discharge visit / OASIS Collection or recert visit following case conference when task appears on action screen.
* Schedules TIF OASIS collection visits and deletes remaining schedule.
* Reschedules declined or missed (if appropriate) visits.
* Processes reassigned and rescheduled visits.
* Ensures supervisory visits are scheduled.
* Runs all scheduling reports including Agent Summary Report and Missed Visits Done on Paper Report.
* Prepares weekly Agent Schedules. Performs initial review of weekly schedule for productivity / geographic issues and forwards schedule to Branch Director for approval prior to distribution to staff.
* Verifies visit paper notes in scheduling console as needed.
* Assists with internal transfer of patients between branch offices.
* If clinical, receives lab reports and assesses for normality, fax a copy of lab to doctor, make a copy for the Case Manager, and route to Medical Records Department. Initiate Employee / Patient Infection Reports as necessary.
* If clinical, may be required to perform patient visits and / or participate in on-call rotation.
Use your skills to make an impact
Required Experience/Skills:
* Be a Licensed Professional Nurse or a Licensed Vocational Nurse licensed in the state in which he / she practices
* Have at least 1 year of home health experience.
* Prior packet review / QI experience preferred.
* Coding certification is preferred.
* Must possess a valid state driver's license and automobile liability insurance.
* Must be currently licensed in the State of employment if applicable.
* Must possess excellent communication skills, the ability to interact well with a diverse group of individuals, strong organizational skills, and the ability to manage and prioritize multiple assignments.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$49,900 - $67,400 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Adjudicator, Provider Claims-Ohio-On the Phone
Molina Healthcare job in Tacoma, WA
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.
Home Health Aide
Tacoma, WA job
Become a part of our caring community and help us put health first A Home Health Aide ( HHA ): * Provides direct patient care to patient under direction of the RN and according to the Aide Plan of Care (POC). * Correctly assists the patient with self-administered medications by opening bottle caps for the patient, reading medication labels to the patient, checking the dose being self-administered against the prescribed dose on the container label and observing the patient takes the medication
* Consistently takes accurate temperature, pulse and blood pressure measurements and recognizes and reports abnormal results to supervisor
* Helps patient maintain good personal hygiene by performing or supervising bathing, grooming, skin care, shaving, oral care, nail/foot care and other activities
* Assists in feeding patients. Is able to communicate basic principles of nutrition, observe and record food and fluid intake when necessary. Safely positions patient for meals and feeds or assists in self feeding
* Assists with patient toileting including use of bed pan/urinal, change and position catheter bags and bag change procedures on well-regulated ostomies
* Provides necessary skills to safely assist the patient with patient mobility, exercises, positioning/turning, transfers and ambulation per Plan of Care and CenterWell Home Health policy
* Provides necessary skills to appropriately report changes and document pertinent information and care rendered to patient to ensure continuity of care. Documents interactions with patients, caregivers, doctors and other staff members appropriately, legibly, thoroughly and in the amount of time allowed
* Practice acceptable infection control principles. Provide a clean, safe and comfortable environment
* Willingly assists with other household duties including light laundry, bed changing and bed making, light meal preparation, light housekeeping and shopping (if no other assistance is available and an MD order is present).
Use your skills to make an impact
Required Experience/Skills:
* High school diploma or equivalent
* Completion of Certified Nursing Assistant or Certified Home Health Aide Program within the last 24 months
* Must meet applicable state certification requirements
* A valid driver's license, auto insurance, and reliable transportation are required
* Must be in good standing on the HHA Registry (if applicable) and have completed HHA/CNA course to work for a Medicare certified agency.
* At least one year experience in the last 24 months as a Home Health Aide or Certified Nursing Assistant in a hospital, nursing home, home health/hospice agency.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$41,300 - $48,200 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Manager, Threat & Crisis Intelligence
Molina Healthcare job in Tacoma, WA
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.
Associate Specialist, Provider Contracts HP
Molina Healthcare job in Tacoma, WA
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.
Field Nurse Practitioner (Shelton, WA)
Molina Healthcare job in Shelton, WA
Provides screening, preventive primary care and medical care services to members - primarily in non-clinical settings where members feel most comfortable, including in-home, community and nursing facilities and “pop up” clinics. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Provides general medical care and care coordination to various and/or specific patient member populations - adult, women's health, pediatric, and geriatric.
• Performs comprehensive evaluations including history and physical exams for gaps in care and preventive assessments.
• Addresses both chronic and acute primary care complaints, and demonstrates ability to ascertain medical urgency.
• Establishes and documents reasonable medical diagnoses.
• Seeks specialty consultation as appropriate.
• Orders/performs pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptoms; works within an environment of limited resources and therefore uses diagnostic tests judiciously and appropriately.
• Understands when a member's needs are beyond their scope of knowledge and when physician oversight is needed.
• Creates and implements a medical plan of care.
• Schedules appointments for visits when appropriate.
• Provides post-discharge coordination to reduce hospital readmission rates and emergency room utilization.
• Performs face-to-face in-person visits in a variety of settings including in-home, skilled nursing facilities, and public locations.
• Performs face-to-face visits via alternative modalities based on business need, leadership direction and state regulations.
• Orders bulk laboratory orders to target specific member populations.
• Performs alternating on-call coverage to triage any urgent lab results and pharmacy inquiries and develops appropriate plans of care.
• Participates in community-based “pop up clinics” to build relationships with communities, and address gaps in health care.
• Drives up to 120 miles a day on a regular basis to a variety of locations within the assigned region. Drives beyond 120 miles as part of extended mileage may be required on special project days. Special projects may include an overnight hotel stay.
• Obtains and maintains cross-state license in other states besides home state based on business need.
• Collaborates with fellow nurse practitioners to develop best practices to perform work duties efficiently and effectively.
• Actively participates in regional meetings.
• May prescribe medications and perform procedures as appropriate.
• Performs timely medical records documentation in electronic medical record (EMR) computer system.
• On occasion, may be required to walk flights of stairs while carrying up to 50 lbs. of equipment.
• Engages in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician to the degree required by state laws.
• Local travel required (based upon state/contractual requirements).
Required Qualifications
• At least 1 year of experience as a nurse practitioner, or equivalent combination of relevant education and experience.
• Active and unrestricted national certification from one of the following organizations: American Academy of Nurse Practitioners (AANP) or American Nurses Credentialing Center (ANCC).
• Current state-issued license to practice as a Family Nurse Practitioner (FNP). License must be active and unrestricted in state of practice.
• Prescriber Drug Enforcement Agency (DEA) license with authority to prescribe per state qualifications. License must be active and unrestricted in state of practice.
• Current Basic Life Support (BLS) certification.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently with minimal supervision and demonstrate self-motivation.
• Responsive in all forms of communication.
• Ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills; ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving and critical-thinking skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency, and electronic medical record (EMR) experience.
Preferred Qualifications
• Experience as a registered nurse or nurse practitioner in a home health, community health or public health setting.
• Experience in home health as a licensed clinician, especially in management of chronic conditions.
• Experience with underserved populations facing socioeconomic barriers to health care.
• Immunization and point of care testing skills.
• Bilingual.
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
#PJNurse
Pay Range: $88,453 - $198,356 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Director, Workforce Management
Auburn, WA job
McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care.
What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you.
Job Summary
We are seeking a leader for our Workforce Management team to join our team in Richmond, VA or any location near an McKesson Medical Surgical (MMS) distribution center.
This position will be responsible for designing and implementing our workforce management solution. The position is the decision maker for the planning, project management oversight, and implementation of the project as well as ongoing administration of the program.
Key Responsibilities:
Strategic Leadership:
* Develop and implement network-wide workforce management strategy
* Lead WFM teams in forecasting, scheduling, and real-time management across multiple distribution centers.
* Partner with senior leadership to align labor planning with financial and operational targets.
* Serve as a thought leader in workforce strategy, contributing to labor initiatives and transformation efforts.
Forecasting & Planning:
* Oversee long-term and short-term labor forecasting models using historical data, seasonal trends, and predictive analytics.
* Collaborate with Finance and Operations to support budgeting and headcount planning.
* Integrate AI/ML models to enhanced forecasting accuracy and responsiveness to demand fluctuations.
Scheduling & Optimization:
* Ensure efficient scheduling practices that balance labor costs with service level goals.
* Implement tools and technologies to automate and optimize scheduling processes.
* Design scalable scheduling frameworks adaptable to future growth and automation.
Performance Monitoring:
* Establish KPIs and dashboards to monitor workforce performance and productivity.
* Drive continuous improvement through data analysis and actionable insights.
* Benchmark performance across sites to identify best practices and standardize excellence.
Technology & Systems:
* Evaluate and implement WFM software solutions.
* Ensure system integrity, data accuracy, and user adoption across the organization.
Compliance & Governance:
* Ensure adherence to labor laws and internal policies.
* Maintain documentation and audit readiness for workforce-related processes.
Team Development:
* Lead, mentor, and develop a high-performing WFM team.
* Foster a culture of accountability, innovation, and collaboration.
Minimum Requirements
* 4-year degree in business or related field strongly preferred, or equivalent experience
* 12+ years in workforce management or operations
* 5+ years experience leading teams and projects in a large, complex company
* Excellent verbal and written communication skills
* Ability to engage and influence people across the organization
* Effective time management and multitasking skills
* Experience with enterprise WFM platforms (Kronos, ADP, Reflexis, Blue Yonder)
* Strong analytical skills with proficiency in tools like SQL, Power BI, or Tableau.
Preferred Skills
* Lean or six sigma certification
* Risk and planning analysis
#LI-JT2
We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here.
Our Base Pay Range for this position
$111,200 - $185,300
McKesson is an Equal Opportunity Employer
McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page.
Join us at McKesson!
Auto-ApplyAssociate Analyst, Clinical Informatics (Bilingual in Spanish Required) - Monday - Friday 7AM - 4PM PST (REMOTE)
Molina Healthcare job in Tacoma, WA
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.
QNXT Configuration Analyst
Molina Healthcare job in Tacoma, WA
Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide.
**Knowledge/Skills/Abilities**
+ Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines.
+ Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.
+ Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management.
+ Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions.
+ Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related.
+ Coordinate, facilitate and document audit walkthroughs.
+ Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal.
+ Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed..
+ Ability to write SQL queries
+ Experience with QNXT configuration
+ Experience with troubleshooting and analyzing issues.
+ Experience working in a Medicare environment is highly preferred.
+ Claims adjudication experience is highly preferred. **Job Qualifications** **Required Education** Associate's Degree or two years of equivalent experience **Required Experience** - Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations: - Analytical experience within managed care operations. - Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. **Preferred Education** Bachelor's Degree **Preferred Experience** - Six years proven analytical experience within an operations or process-focused environment. - Previous audit and/or oversight 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: $77,969 - $116,835 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Supervisor, Healthcare Services Operations Support
Molina Healthcare job in Tacoma, WA
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.
Speech Therapist, Home Health
Puyallup, WA job
Become a part of our caring community and help us put health first As a therapist at CenterWell Home Health, you'll play a vital role in helping patients regain strength, mobility and independence-all from the comfort of their homes. By delivering personalized care that focuses on rehabilitation and functional improvement, you'll empower individuals to overcome physical limitations, perform everyday activities with confidence and enjoy a better quality of life.
As a Home Health Speech Therapist, you will:
* Evaluate, direct and provide speech/language pathology service to patients in the home or facility
* Participate in the development and periodic review of the Plan of Treatment and Plan of Care.
* Utilize professional skills and judgment in assessing and treating disorders of speech, voice, language, hearing and swallowing to prevent, identify, evaluate and minimize the effects of such disorders and conditions.
* Administer and interpret diagnostic tests and applications of therapeutic treatments including audio logic screening.
* Observe, record and report changes in the patient's condition and response to treatment to supervisor and/or the physician.
* Provide instruction and training to patients in use of alternative communication systems when appropriate.
* Provide counsel and instruction to patients, families and healthcare staff.
* Maintain and submit documentation as required by the Company and/or facility. Prepare and submit timely written reports of evaluations, visits, summaries, care plans, care coordination activities and progress reports as required by Company policy.
* Participate in care coordination activities and discharge planning.
* Maintain the highest standards of professional conduct in relation to information that is confidential in nature. Share information only when the recipient's right to access is clearly established and the sharing of such information is clearly in the best interests of the patient.
* Attend, participate in and/or conduct internal staff development programs, obtain continuing education as required by Company policy, regulation.
Use your skills to make an impact
Required Experience/Skills:
* Meet the education and experience requirements for Certification of Clinical Competence in Speech Language Pathology or Audiology granted by ASHA
* Minimum of six months experience as a speech therapist / speech language pathologist
* Home Health experience a plus
* Current and unrestricted license
* Current CPR certification
* Good organizational and communication skills
* A valid driver's license, auto insurance, and reliable transportation are required.
Pay Range
* $58.00 - $81.00 - pay per visit/unit
* $84,900 - $116,800 per year base pay
Scheduled Weekly Hours
20
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$84,900 - $116,800 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Director, General Accounting
Olympia, WA job
**Become a part of our caring community and help us put health first** The Director, General Accounting performs general accounting activities, including the preparation, maintenance and reconciliation of ledger accounts and financial statements such as balance sheets, profit-and-loss statements and capital expenditure schedules. Conducts or assists in the documentation of accounting projects. The Director, General Accounting requires an in-depth understanding of how organization capabilities interrelate across the function or segment.
The Director, General Accounting prepares, records, analyzes and reports accounting transactions and ensures the integrity of accounting records for completeness, accuracy and compliance with accepted accounting policies and principles. Provides financial support, including forecasting, budgeting and analyzing variations from budget. Analyzes and prepares statutory accounts, financial statements and reports. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.
**Use your skills to make an impact**
**Required Qualifications**
+ Master's Degree
+ 8 or more years of technical experience
+ 5 or more years of management experience
+ Progressive financial and accounting analysis experience
+ Progressive leadership and management experience
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
**Preferred Qualifications**
+ Master's Degree in Business Administration
+ Certified Public Accountant license
+ Prior experience in public accounting and auditing
+ Strong technical accounting skills
+ Prior insurance operations or financial industry experience
+ Knowledge of relational databases such as Access and SQL Server
+ Certified Public Accountant license
**Additional Information**
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$168,000 - $231,000 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-16-2025
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
Senior Analyst, Business
Molina Healthcare job in Tacoma, WA
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.
**Recoveries & Disputes**
+ Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines.
+ Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions.
+ Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments.
+ Provide actionable insights and recommendations to leadership to drive continuous improvement.
**Skills & Competencies**
+ Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment.
+ In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage.
+ Strong understanding of claim system configurations, payment policies, and audit processes.
+ Exceptional analytical, problem-solving, and documentation skills.
+ Ability to translate complex business problems into clear system requirements and process improvements.
+ Proficiency in Excel
+ Knowledge in QNXT preferred
+ Strong communication and stakeholder management skills with ability to influence across teams.
**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: $77,969 - $128,519 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Pharmacy Representative
Molina Healthcare Inc. job in Tacoma, WA
JOB DESCRIPTION Job SummaryProvides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.
Essential Job Duties
* Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards.
* Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
* Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies.
* Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated.
* Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes.
* Assists members and providers with initiating verbal and written coverage determinations and appeals.
* Records calls accurately within the pharmacy call tracking system.
* Maintains established pharmacy call quality and quantity standards.
* Interacts with appropriate primary care providers to ensure member registry is current and accurate.
* Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation.
* Proactively identifies ways to improve pharmacy call center member relations.
Required Qualifications
* At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience.
* Excellent customer service skills.
* Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc.
* Ability to multi-task applications while speaking with members.
* Ability to multi-task applications while speaking with members.
* Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors.
* Ability to meet established deadlines.
* Ability to function independently and manage multiple projects.
* Excellent verbal and written communication skills, including excellent phone etiquette.
* Microsoft Office suite (including Excel), and applicable software program(s) proficiency.
Preferred Qualifications
* Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice.
* Health care industry experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $21.16 - $28.82 / HOURLY
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
Registration Representative- St. Michael Medical Center - Poulsbo
Silverdale, WA job
Responsible for duties in support of departmental efficiencies which may include: but not limited to performing administrative duties, scheduling, registration, reception and patient check out functions. Must obtain complete and accurate patient demographic information. Registration Representatives also must employ proper, compliant patient liability collection techniques before, during & after date of service.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
* Administrative duties, to include but not limited to, schedule management, including calendars and schedules for providers at various facilities. Takes meeting notes, minutes and follow up action items. Completes data entry assignments along with creating various reports for departments and management.
* Greeting customers following Conifer Standards of Care, provides world-class customer service, completes full patient registration on date of service, adheres to financial & cash control policies & procedures, thoroughly explains and secures Hospital & patient legal forms (i.e., Advance Directives, Conditions of services, Consent for treatment, Important Message from Medicare, EMTALA, etc.). Scan Protected Health Information, create and file patient information packets/folders for upcoming Hospital services. Schedules diagnostic procedures (enters data in scheduling system, provide customer with appointment instructions, other tasks as needed).
* Educates patients about patient financial liabilities, employs proper, compliant patient liability collection techniques before, during & after date of service, performs Hospital cash reconciliation & secured payment entry in adherence to financial & cash control policies & procedures.
* Secures medical necessity checks/verification in accordance to Centers for Medicare & Medicaid services, verifies insurance, benefits, coverage & eligibility, completes assigned registration financial clearance work lists activities, obtains insurance authorizations for scheduled & unscheduled Hospital services, and secures inpatient visit notification to payors. Performs scheduling, checks out patients and coordinates after care for patients.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* Minimum typing skills of 35 wpm
* Demonstrated working knowledge of PC/CRT/printer
* Knowledge of function and relationships within a hospital environment preferred
* Customer service skills and experience
* Ability to work in a fast-paced environment
* Ability to receive and express detailed information through oral and written communications
* Course in Medical Terminology required
* Understanding of Third-Party Payor requirements preferred
* Understanding of Compliance standards preferred
* Must be able to perform essential job duties in a Patient Access service area.
* Uses proper negotiation techniques to professionally collect money owed by our Patients/Guarantors.
* Builds and maintains collaborative relationships with both internal and external Clients that lead to more effective communication and a higher level of productivity and accuracy.
* Must be able to appropriately interpret physician orders, medical terminology and insurance cards while maintaining Conifer Standards of Care.
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
* High School Diploma or GED required
* 0 - 1 year in a Customer Service role.
* 0 - 1 year administrative experience in medical facility, health insurance, or related area preferred
* Some college coursework is preferred
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* Must be able to sit at computer terminal for extended periods of time
* Occasionally lift/carry items weighing up to 25 lbs.
* Frequent prolonged standing, sitting, and walking
* Occasionally push a wheelchair to assist patients with mobility problems.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* Hospital administration
* Can work in patient care locations which include potential exposure to life-threatening patient conditions.
OTHER
* Must be available to work hours and days as needed based on departmental/system demands.
* Resolves Physician's office and Patient issues. May experience extreme patient volumes and uncooperative Patients.
As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
Compensation and Benefit Information
Compensation
* Pay: $17.46-$26.25 per hour.
* Shift differentials of $1.00-$2.50/per hour may be available depending on the shift worked.
* Conifer observed holidays receive time and a half.
Benefits
Conifer offers the following benefits, subject to employment status:
* Medical, dental, vision, disability, and life insurance
* Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
* 401k with up to 6% employer match
* 10 paid holidays per year
* Health savings accounts, healthcare & dependent flexible spending accounts
* Employee Assistance program, Employee discount program
* Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet participates in the E-Verify program. Follow the link below for additional information.
E-Verify: *****************************
The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.
**********
Senior Manager, MarketPoint Sales - Raleigh Durham, NC.
Olympia, WA job
**Become a part of our caring community and help us put health first** With over 10 million sales interactions annually, Humana understands that while great products are important, it's the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does.
Are you passionate about the Medicare population, looking for a role in management with the ability to directly impact your own income potential? If so, we are looking for licensed, highly motivated and self-driven individuals to join our team. Our Senior Manager, Medicare Sales, motivates and drives a team of Medicare Sales Field Agents who sell individual health plan products and educate beneficiaries on our services in a field setting. Our teams also sell Life, Annuity, Indemnity, Dental, Vision, Prescription plans, and more.
Humana has an inclusive and diverse culture welcoming candidates with multilingual skill sets to service our consumers.
**This role is** **field** **based, and you will be out and about in the field in the Raleigh** **Durham, NC.** **area working with your team and meeting members face to face. You must reside in Raleigh** **Durham, NC.** **area or be willing to relocate to the area.**
In this **field** position, you will; coach, mentor, educate, motivate and train a team of sales individuals. The Senior Manager, Medicare Sales, must have a solid understanding of the market they serve, how to resolve operational problems and provide creative solutions to increase sales while following CMS guidelines. This role also involves cultivating, maintaining, and building relationships with Humana's customers, both internal and external business partners, along with the community we serve through telephonic, virtual, and face-to-face interactions with individuals and groups. Other responsibilities include developing marketing budgets, and looking for branding opportunities.
**Use your skills to make an impact**
**Required Qualifications**
+ **Must reside in the** **Raleigh** **Durham, NC.** **area or be willing to relocate**
+ **Active Health & Life Insurance Licenses**
+ 2 or more years of sales leadership experience
+ 6 or more years of experience working in the insurance industry
+ Must be able to travel up to 50% of the time
+ Ability to lead a team of sales associates and train them in successful sales techniques, educational presentation skills, utilizing technology tools as well as building relationships with communities and medical providers
+ Strong aptitude for technology with proficiency in MS Office products, various CRM platforms, and various iPhone app capabilities
+ Must be a strong leader, strong producer
+ Strong organizational, interpersonal, communication and presentation skills
+ Ability to adapt and overcome when necessary
+ Community Engagement/Grassroots experience in marketing Medicare plans in the community
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
+ This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits
**Preferred Qualifications**
+ Bachelor's Degree
+ Prior experience working in Medicare and the health solutions industry
+ Engaged with the community through service, organizations, activities and volunteerism
+ Project management background or certification a plus
+ Bilingual with the ability to speak, read and write without limitations or assistance
**Humana Perks:**
Full time associates enjoy:
+ Base salary with a competitive commission structure
+ Medical, Dental, Vision and a variety of other supplemental insurances
+ Paid time off (PTO) & Paid Holidays
+ 401(k) retirement savings plan
+ Tuition reimbursement and/or scholarships for qualifying dependent children.
+ And much more!
**Social Security Task:**
Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions to add the information into the application at Humana's secure website.
**Virtual Pre-Screen:**
As part of our hiring process for this opportunity, we will be using exciting virtual pre-screen technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a virtual pre-screen, you will receive an email and text correspondence inviting you to participate in a HireVue interview. In this virtual pre-screen, you will receive a set of questions to answer. You should anticipate this virtual pre-screen to take about 10-15 minutes.
\#MedicareSalesManager \#MedicareSalesReps
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$77,000 - $105,100 per year
This job is eligible for a commission incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-18-2025
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
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