Molina Healthcare jobs in Riverside, CA - 275 jobs

Provides support for coordination of benefits review activities that directly impact medical expenses and premium reimbursement. Responsible for primarily coordinating benefits with other carriers responsible for payment. Facilitates administrative support, data entry, and accurate maintenance of other insurance records. Job Duties Provides telephone, administrative and data entry support for the coordination of benefits (COB) team. Phones or utilizes other insurance company portals to validate state, vendor, and internal COB leads. Updates the other insurance table on the claims transactional system and COB tracking database. Review of claims identified for overpayment recovery. Job Qualifications REQUIRED QUALIFICATIONS: At least 1 year of administrative support experience, or equivalent combination of relevant education and experience. Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. Strong verbal and written communication skills. Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders. Microsoft Office suite proficiency. PREFERRED QUALIFICATIONS: Health care experience To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Per Diem / PRN Nurse RN - Case Management - $77 per hour at HealthTrust Workforce Solutions Local summary: This per diem Registered Nurse (RN) position specializes in case management, offering flexible shifts primarily in Riverside, California. The role requires at least one year of specialty experience and appropriate certifications, with benefits including self-scheduling, weekly pay, and 401K matching. The position is supported by HealthTrust Workforce Solutions, providing access to a broad network of healthcare facilities and career development opportunities within HCA Healthcare. HealthTrust Workforce Solutions Local is seeking a per diem / prn nurse RN Case Management for a per diem / prn nursing job in Riverside, California. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: Duration: Ongoing Employment Type: Per Diem Entrust Your Career to HealthTrust! At HealthTrust, we believe that healthcare is not defined by the four walls in which it is practiced; it's defined by its people. We pride ourselves on crafting opportunities that expand skill sets, broaden career horizons, provide economic stability, and cultivate personal growth. HealthTrust Offers: Getting to know HCA facilities within 50mi of home zip code Self scheduling through our Mobile GO HWS App Minimum of just three shifts a month, however, you can work more! 401K Matching Night shifts are not required Weekly pay every Friday Not required to work weekends Not Required to work holidays To get started, you will need: RN's a minimum of 1 year in specialty Allied 6 months of experience An adventurous spirit and fierce dedication Degree in corresponding specialty as required Appropriate certifications for the specific position HealthTrust Benefits: Opportunities for a lifetime: When you become a part of the HCA family, you will have exclusive access to more opportunities than any other healthcare system in the nation. At HWS, we help open the door to a lifetime of lasting career opportunities. A culture of care: Our clinicians have made HWS an industry leader for over 25 years. We are passionate about our mission that, above all else, we are committed to the care and improvement of human life. Career Development: As a wholly owned subsidiary of HCA Healthcare, HWS is a preferred partner to thousands of top-performing hospitals. We provide our healthcare professionals with first-priority access to more than 200,000 jobs nationwide. We are uniquely positioned to offer you exclusive and direct access to HCA Healthcare's vast network of facilities. Let us open the door to nationwide opportunities that fit your lifestyle! We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. HealthTrust Workforce Solutions Per Diem Job ID #918144. Posted job title: Per Diem Nurse - Case Management Keywords: Per diem nurse, Registered Nurse, RN case management, Healthcare jobs, Nursing shifts, Flexible nursing schedule, HCA Healthcare, Nursing career development, Case management nurse, Healthcare staffing

Salary Estimate: $63710.40 - $92414.40 / year Learn more about the benefits offered ( ********************************************************************* ) for this job. The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range. **Job Summary and Qualifications** The Graduate Medical Education (GME) Program Administrator is responsible for supporting the administrative, operational and financial management functions of the assigned residency/fellowship training program. The GME Program Administrator assists GME leaders in providing an optimal working and learning environment for all trainees. The position requires a comprehensive and detailed understanding of Accreditation Council for Graduation Medical Education (ACGME), hospital policies, as well as a high degree of initiative and independent judgment. The Program Administrator will continually assess and direct a wide range of programmatic issues including long range planning, recruiting trainees, onboarding trainees, developing projects, analyzing administrative workflow, maintaining databases, communicating with faculty and trainees regarding a range of issues, developing faculty and managing internal and external program relations. The Program Administrator supports the education design and leadership of the residency program, and therefore, shares responsibility for the residents, faculty and other colleagues within the program. What you will do in this role: + Manage the day-to-day operations of one or more residency or fellowship training programs. + Coordinate and organize program recruitment efforts and the National Resident Matching Program (NRMP) process. + Understand the program accreditation requirements and assist in ensuring compliance of the program, residents, and faculty with all applicable requirements. + Prepare and maintain all required program/resident documentation. + Coordinate program/resident onboarding and orientation processes. + Serve as the resident/fellow liaison to assure a positive educational experience. + Continuously assess and coordinate a wide range of programmatic events and processes, including curricular activities, onboarding and graduation, periodic assessment, budget planning and maintenance, annual Accreditation Council for Graduate Medical Education (ACGME) program updates and accreditation site visits, and more. What qualifications you will need: + Bachelor's degree preferred + Minimum 3 years of experience in a healthcare setting (preferably in Graduate Medical Education or in some field of education, i.e. teacher/educator) preferred + Training Administrators of Graduate Medical Education (TAGME) certification highly regarded + Knowledge of Residency Management Systems (MedHub or New Innovations) preferred + Proficiency with MS Word, Excel, PowerPoint, PDF software, online meeting platforms, email and other forms of electronic communication + Ability to efficiently and accurately manage multiple tasks and projects + Excellent written and verbal communication skills **Benefits** Riverside Community Hospital offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity and Consumer Discounts + Retirement readiness, rollover assistance services and preferred banking partnerships + Education assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) + Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits (*********************************************************************) _Note: Eligibility for benefits may vary by location._ Our teams are a committed, caring group of colleagues. Do you want to work as a(an) Program Administrator GME where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise! Supporting HCA Healthcare's 186 hospitals and 2,400+ sites of care, Physician Services plays a crucial role as the main entry point for patients looking for high-quality healthcare within the HCA Healthcare system. With a focus on meeting the needs of our patients at all access points, Physician Services is dedicated to implementing innovative, physician-driven, value-added solutions to assist physicians in providing high-quality, patient-centered care, aligning with our mission to care for and enhance human life. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in costs for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Program Administrator GME opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. **Unlock the possibilities and apply today!** We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Local Contract Nurse RN - NICU - Neonatal Intensive Care - $76-77 per hour at HealthTrust Workforce Solutions Regional summary: This local contract nursing position seeks a Registered Nurse specialized in Neonatal Intensive Care (NICU) to provide acute care for newborns in a Level III NICU setting. The role requires at least three years of NICU experience, CA RN licensure, and certifications in BLS and NRP, working 12-hour day shifts over a 13-week contract. Responsibilities include patient care with typical procedures such as line placement and intubations while using EMR systems like Meditech and CPN. HealthTrust Workforce Solutions Regional is seeking a local contract nurse RN NICU - Neonatal Intensive Care for a local contract nursing job in Riverside, California. Job Description & Requirements Specialty: NICU - Neonatal Intensive Care Discipline: RN Duration: 13 weeks 36 hours per week Shift: 12 hours, days Employment Type: Local Contract • Number of Beds - 21 flex to 37 • Number of Staff - 60 • Type of staff: 1 charge, 10 nurses • Patient Ratios - 1:1, 1:2, 1:3 • EMR - Meditech and CPN • Floating: Postpartum • Weekends: At least every other • Typical Procedures: - Line Placement - Intubations Must Haves: - An ASN degree minimum, BSN preferred - A recent 3 years of Level III NICU RN experience in an acute hospital setting - Ability to take babies from Level I - Level III - CA RN License - BLS and NRP Certifications Preferred or Nice to Have: - Delivery Experience - MediTech Experience - Travel Experience Keywords: NICU nurse, neonatal intensive care, registered nurse RN, level III NICU, acute hospital nursing, BLS certification, NRP certification, Meditech EMR, line placement, intubation procedures

Who We Are We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community. Our Story We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care. We have a rich history at Tenet. There are so many stories of compassionate care; so many 'firsts' in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need. Tenet and our predecessors have enabled us to touch many different elements of healthcare and make a difference in the lives of others. Our Impact Today Today, we are leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions. Our impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. We are differentiated by our top notch medical specialists and service lines that are tailored within each community we serve. The work Conifer is doing will help provide the foundation for better health for clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions. Together as an enterprise, we work to save lives and can accept nothing less than excellence from ourselves in service of our patients and their families, every day. DEPARTMENT SPECIFIC DUTIES: Priority 1. Oversee coordination of clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post- acute care) compared to evidence-based practice, internal and external requirements. (40% daily, essential), Priority 2. Oversee department operations (staffing, scheduling, education, budget etc). (20% daily, essential). Priority 3. Perform data gathering, analysis and reporting. (20% daily essential). Priority 4. Remain current with relevant clinical/ case management practices. Attend and participate in meetings related to Quality, Operational and Financial improvement (20% daily, essential). All staff assigned to department (case managers, social workers, case manager assistants, administrative assistants). Other responsibilities as assigned e.g. disaster preparedness The metrics below provide an indication of the effectiveness of the individual in this role and may be used for evaluative purposes. The list below is not meant to be exhaustive; other relevant metrics may exist. * Compliance with Tenet Case Management policies * Obtaining valid physician order prior to bed placement * InterQual reviews * Observation hours * Excess Days/ALOS * Clinical disputes - incidence and dollars * Number and type of avoidable days * Resource Utilization * At least 5 hours of CEUs per year on topics related to Case Management. This position qualifies for a $20,000 Sign-On Bonus! Desert Regional Medical Center is a 385-bed acute-care hospital classified as a stroke receiving center and level 2 trauma facility with an innovative, patient centered and evidence-based Rehabilitation Services Department. Our compassionate team provides a wide range of inpatient and outpatient services, including acute care rehabilitation, joint replacement & spinal surgery, neurosurgery, ICU, Telemetry, step-down care, skilled nursing, as well as outpatient therapy, hand and lymphedema clinics. General Duties: The individual in this position has overall responsibility for operational management of the Case Management Department, Social Services and Bed Control; including staffing, budgets and plans. The individual's responsibilities will include, but not be limited to the following activities: a) Complying with relevant Tenet policies including Case Management and Clinical Determination Policies b) implementing and revising the UM Plan and promoting cooperation with utilization review standards by the medical staff c) Maintaining / facilitating communication between the case management department and the physician advisor on a regular basis regarding utilization review and/or quality issues d) Maintaining / facilitating communication between the case management department and the physicians as well as other members of the healthcare team e) analysis of reports: LOS, avoidable days, disputes, InterQual and associated metrics f) Responsible for implementation and compliance with all policies and regulations relating to the functioning of the case management department g) and all other duties as assigned Attends a workshop webinar led by PMI Case Management leadership or designee that includes the Tenet Case Management Model and other topics specific to role and responsibilities. Information used to perform job: patient data, healthcare staff documentation related to patient care, regulatory and payor requirements, budgetary and operations data Software used to perform job: eCCM: Clinical data interface, InterQual, Case Management documentation, secure faxing, Avoidable Day tracking, Patient Medical Record and HPF, hospital specific Clinical Software, Enterprise Reporting: Decision Support reports, PMI reports, Care Discovery, Position Control Required: * Registered Nurse with a BSN and an RN License * Extensive management and clinical experience * Experience in improving organizational performance * Experience in facilitating and leading multidisciplinary teams * Minimum of 3 years of experience as a case manager * Strong written and verbal communication skills * Demonstrated ability to organize and work with groups of people * Ability to present data to professional groups and institute changes based on the data presented * Demonstrates effective problem solving and decision-making skills Preferred: * Registered Nurse with a BSN and a California RN License PHYSICAL REQUIREMENTS: While performing the duties of this job, the employee is regularly required to sit, talk, and hear. The employee is frequently required to use fine motor skill (typing/data entry), and reach with hands and arms. The employee is frequently required to stand; walk; and occasionally stoop, kneel, or crawl. The employee must regularly lift and /or move up to 20 pounds and occasionally lift and/or move up to 50 pounds. Individual works in both a clinical and office environment. Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law. 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. **********

Who We Are We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community. Our Story We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care. We have a rich history at Tenet. There are so many stories of compassionate care; so many 'firsts' in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need. Tenet and our predecessors have enabled us to touch many different elements of healthcare and make a difference in the lives of others. Our Impact Today Today, we are leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions. Our impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. We are differentiated by our top notch medical specialists and service lines that are tailored within each community we serve. The work Conifer is doing will help provide the foundation for better health for clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions. Together as an enterprise, we work to save lives and can accept nothing less than excellence from ourselves in service of our patients and their families, every day. Desert Regional Medical Center is a 385 bed acute-care hospital classified as a stroke receiving center and level 2 trauma facility with an innovative , patient centered and evidence-based Rehabilitation Services Department. Our compassionate team provides a wide range of inpatient and outpatient services, including acute care rehabilitation, joint replacement & spinal surgery, neurosurgery, ICU, Telemetry, step-down care, skilled nursing, as well as outpatient therapy, hand and lymphedema clinics. Summary * The Social Worker is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and right to self-determination. * The individual in this position has overall responsibility for to assess the patient for transition needs including identifying and assessing patients at risk for readmission. * Conducts complex psycho-social assessment and intervention to promote timely throughput, safe discharge and prevent avoidable readmissions. * This position integrates national standards for case management scope of services including: * Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction * Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care * Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy * Education provided to physicians, patients, families and caregivers •Leads a population of patients by service line and/or leads the team by being a resource to Tenet performance standards. Responsibilities This individual's responsibility will include the following activities: * Complex psycho-social transition planning assessment and reassessment and intervention, * Assistance with adoptions, abuse and neglect cases, including assessment, intervention and referral as appropriate to local, state and /or federal agencies, * Care coordination, d) implementation or oversight of implementation of the transition plan, * Leading and/or facilitating multi-disciplinary patient care conferences including Complex Case Review, * Making appropriate referrals to other departments, g ) communicating with patients and families about the plan of care, * Collaborating with physicians, office staff and ancillary departments, I) assuring patient education is completed to support post-acute needs , * Timely complete and concise documentation in Case Management system, k ) maintenance of accurate patient demographic and insurance information, * Precepts new staff members and acts as a resource to all staff, * Facilitates TEMPO as needed, * Participates in department quality improvement initiatives, and * Other duties as assigned. Qualifications Experience Preferred: Two (2) years acute hospital experience. Certifications * Required: LCSW based on license requirements of the state in which the Tenet Hospital operates. * Preferred: Accredited Case Manager (ACM). Sign On Bonus: Up to $25,000 Hours: 1200pm - 12:30am Schedule: Fridays through Sunday #LI-DH1 Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law. 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. **********

The Senior Facilitated Enroller will use a high degree of customer service to successfully work with the team to provide optimal enrollment success. The Senior Facilitated Enroller (SFE) will assist the Facilitated Enrollment Supervisor in meeting and exceeding sites expectations and providing exceptional levels of customer service. The SFE will continue to assist eligible recipients for enrollment by phone or conduct face to face meetings. Assist the Facilitated Enrollment Supervisor in training, assisting with client meetings (webinars and leading meetings) and will be more involved with the Marketing Tracker and Salesforce. The SFE will also work closely with the Facilitated Enroller and will report to the Facilitated Enrollment Supervisor the successes or areas that require improvement and will provide input on strategy as the business needs change within given territory. Knowledge/Skills/Abilities Assists with inbound/outbound calls when necessary to assist FE with achieving monthly, quarterly and annual enrollment goals. The SFE will assist in leading FE and/or projects to help ensure monthly enrollment results. SFE will provide support across projects, including quality checks to Marketing Tracker and Sales Force. Works with Facilitated Enrollment Supervisor to successfully support FEs in enrollment success and to formulate resolutions for struggling FEs. Identifies any challenges and communicates to Facilitated Enrollment Supervisor. Successfully maintains and/or manages monthly FE calendar Excellent time management with the ability to maintain multi-faceted projects, providing both quality and quantity while completing job duties and adhering to various objectives with little to no supervision. Maintains a high level of professionalism to all outgoing emails to clients Shows a comprehensive understanding of processes, best practices, and indications with minor errors Monitors daily operations and identifies need for program tools and works with Facilitated Enroller Supervisor to meet staff needs. Participates in the design and implementation of process improvements within the current facilitated enrollment policies, procedures, services and workflow to improve the customer experience as well as productivity Maintains expert knowledge of current processes, rules and regulations of the MMC, EP, CHP and QHP programs and serves as a resource for implementation, training teams Offers suggestions to Facilitated Enrollment Supervisor regarding corrective action plans and conducts other quality activities to include policy and procedure review and application reviews Performs research assignments as directed by Facilitated Enrollment Supervisor which may include but are not limited to educational resources and best practices. Meets with consumers at various sites throughout the communities Provide education and support to individuals who are navigating a complex system by assisting consumers with application process, explaining requirements and necessary documentation Consistently demonstrates high standards of integrity by supporting Molina Healthcare of NY, Inc mission and values and adhering to the Corporate Code of Conduct Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures Performs other functions as assigned by management. Job Qualifications Required Education: High School Diploma or equivalence Required Experience: Minimum of 3 years of experience working with State and Federal Health Insurance programs and populations Demonstrated organizational skills, time management skills and ability to work independently Previous experience leading projects, processes, or teams Excellent written and oral communication skills; strong presentation skills Basic computer skills including Microsoft Word, Excel, Salesforce and Share Point Strong interpersonal, organizational skills and the ability to work in a team environment. A positive attitude with the ability to be flexible and adapt to change Knowledge of Managed Care insurance plans Ability to work with a diverse population, including different ethnicities, cultural backgrounds, and/or underserved communities Required Licensure or Certification: Must have reliable transportation and a valid NYS drivers' license with no restrictions Successful completion of the NYSOH required training, certification 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.

**Candidates for this position must live in or near the following areas, , McAllen, Mission, Edinburg, or Pharr Texas.** Are you passionate about serving your community? Do you have established relationships within the community? Come join our growing Community Engagement team at Molina Healthcare! Community Engagement is more than just participating in events-at Molina, we focus on making an impact on people's lives! This role involves working with a wide variety of community partners to grow Molina's membership and improve the health and well-being of the Community. Under limited supervision, you will be responsible for carrying out enrollment events and activities to help grow Molina Healthcare as the choice Medicaid provider in the community. You will do this by hosting and attending community events, delivering presentations, attending meetings, distributing educational materials, health fairs and more. This is a Field-Based position. You will be in the field engaging with CBO's (Community Based Organizations) 75% or more of the time (Molina reimburses mileage). This position offers great flexibility and allows for you to manage your territory and schedule to meet business needs. Knowledge of the Medicaid market. State Medicaid programs such as CHIP, STAR, and STAR PLUS programs highly desired. KNOWLEDGE/SKILLS/ABILITIES Responsible for achieving established goals improving Molina's enrollment growth objectives encompassing Medicaid programs. Works collaboratively with key departments across the enterprise to improve overall choice rates and assignment percentages Under limited supervision, responsible for carrying out enrollment events and achieving assigned membership growth targets through a combination of direct and indirect marketing activities, with the primary responsibility of improving the plan's overall “choice” rate. Works collaboratively with other key departments to increase the Medicaid assignment percentage for Molina. Works closely with other team members and management to develop/maintain/deepen relationships with key business leaders, community-based organizations (CBOs) and providers, ensuring all efforts are directed towards building membership for Medicaid and related programs. Effectively moves relationships through the “enrollment” pipeline. Responsible for achieving monthly, quarterly, and annual enrollment goals, and growth and choice targets, as established by management. Schedules, coordinates & participates in enrollment events, encourages key partners to participate, and assists where feasible. Works cohesively with Provider Services to ensure providers within assigned territory are aware of Molina products and services. Establishes simple referral processes for providers and CBOs to refer clients who may be eligible for other Molina products. Viewed as a “subject matter expert” (SME) by community and influencers on the health care delivery system and wellness topics. Delivers presentations, attends meetings and distributes educational materials to both members and potential members. Assists with all incoming calls and assist perspective members or members with health access related questions. Identify partnerships with key sponsorship opportunities and provide justification to determine Molina's participation. Identify and promote Molina's programs out in the community and creates opportunities for employees to participate. Responsible for managing their own daily schedule in alignment with department goals and initiatives as assigned by regions. Key in the development of SMART goals and provide input on department priorities. **Candidates for this position must live in or near the following areas, McAllen, Mission, Edinburg, or Pharr Texas.** Bilingual (Spanish) Highly Desired JOB QUALIFICATIONS Required Education: Bachelor's Degree or equivalent, job-related experience. Preferred Education: Bachelor's Degree in Marketing or related discipline. Required Experience: Min. 3 years of related experience (e.g., marketing, business development, community engagement, healthcare industry). Demonstrated exceptional networking and negotiations skills. Demonstrated strong public speaking and presentations skills. Demonstrated ability to work in a fast-paced, team-oriented environment with little supervision. Must be able to attend public events in outdoor venues in all weather conditions. Must be able to sit and stand for long periods. Must be able to drive up to 3 hours to attend events. Must be able to lift 30 pounds. Required License, Certification, Association: Completion of Molina /DHS/MRMIB Marketing Certification Program/Covered CA Certified. Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation. Preferred Experience: Solid understanding of Health Care Markets, primarily Medicaid. Previous healthcare marketing, enrollment and/or grassroots/community outreach experience a plus. 5 years of outreach experience serving low-income populations. 3 - 5 years project management experience, preferably in a health care or outreach setting. Experience presenting to influencer and low-income audiences. Experience in sales or marketing techniques. Fluency in a second language highly desirable. Preferred License, Certification, Association: Active Life & Health Insurance Market Place Certified 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. Key Words: CHIP, STAR, Medicare, Medicaid, Star Plus, health coach, community health advisor, family advocate, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter and public health aide, community lead, community advocate, nonprofit, non-profit, social worker, case worker, housing counselor, human service worker, Navigator, Assistor, Connecter, Promotora, Marketing,

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

The Specialist, Practice Transformation implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Drives provider practices to ensure assigned Tier 2 & Tier 3 Practice Transformation plan is in place and carried out to meet annual quality & risk adjustment performance goals. Job Duties Ensures assigned Tier 2 & Tier 3 providers have a Practice Transformation plan to meet annual quality & risk adjustment performance goals. Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution. Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes. Drives provider participation in Molina risk adjustment and quality efforts (e.g. Supplemental data, EMR connection, Clinical Profiles programs) and use of the Molina Provider Collaboration Portal. Tracks all engagement and training activities using standard Molina Provider Engagement tools to measure effectiveness both within and across Molina Health Plans. Serves as a Practice Transformation subject matter expert; works collaboratively within the Health Plan and with shared service partners to ensure alignment to business goals. Accountable for use of standard Molina Practice Transformation reports and training materials. Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities. Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies. Communicates comfortably and effectively with Physician Leaders, Providers, Practice Managers, Medical Assistants within assigned provider practices. Maintains the highest level of compliance. This position may require same day out of office travel approximately 0 - 80% of the time, depending upon location. JOB QUALIFICATIONS REQUIRED QUALIFICATIONS: Associate's degree or equivalent combination of education and work experience. Min 1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience. Experience with various managed healthcare provider compensation methodologies including but not limited to: fee-for service, value-based care, and capitation Strong working knowledge of Quality metrics and risk adjustment practices across all business lines Demonstrates data analytic skills Operational knowledge and experience with PowerPoint, Excel, Visio Effective communication skills PREFERRED QUALIFICATIONS: Degree in Preferred field: Clinical Quality, Public Health or Healthcare. 1 year of experience in Medicaid and/or Medicare managed care 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.

Who We Are We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community. Our Story We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care. We have a rich history at Tenet. There are so many stories of compassionate care; so many 'firsts' in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need. Tenet and our predecessors have enabled us to touch many different elements of healthcare and make a difference in the lives of others. Our Impact Today Today, we are leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions. Our impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. We are differentiated by our top notch medical specialists and service lines that are tailored within each community we serve. The work Conifer is doing will help provide the foundation for better health for clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions. Together as an enterprise, we work to save lives and can accept nothing less than excellence from ourselves in service of our patients and their families, every day. This role provides direct clinical patient care. The role will assume responsibility for assessing, planning, implementing direct clinical care to assigned patients on a per shift basis, and unit level. The role is responsible for supervision of staff to which appropriate care is delegated. The role is accountable to support CNO to ensure high quality, safe and appropriate nursing care, competency of clinical staff, and appropriate resource management related to patient care in the following areas: All Critical Care CCU/ICU, ER, NICU, CVICU PICU, MICU, Radiology, Dialysis, PACU, CVOR, Labor and Delivery, OR, Cardiac Cath Lab, and GI/Endo. This position will be required to travel overnight or temporarily relocate to support a facility or facilities in a market as needed. This role will be required to be assigned to various hospitals or markets as needed. 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. **********

Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service. Job Duties This role serves as the primary point of contact between Molina Health plan and the Plan's Complex Provider Community that services Molina members, including but not limited to Value Based Payment and other Alternative Payment Method contracts. It is an external-facing, field-based position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage complex providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership. • Under general supervision, works directly with the Plan's external complex providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. • Resolves complex provider issues that may cross departmental lines including Contracting, Finance, Quality, Operations, and involve Senior Leadership. • Responsible for Provider Satisfaction survey results. • Develops and deploys strategic network planning tools to drive Provider Relations and Contracting Strategy across the enterprise. • Facilitates strategic planning and documentation of network management standards and processes. Effectiveness is tied to financial and quality indicators. • Works collaboratively with functional business unit stakeholders to lead and/or support various provider services functions with an emphasis on developing and implementing standards and best practices sharing across the organization. • MCST matrix team environmental support including, but not limited to: New Markets Provider/Contract Support Services, PCRP & CSST resolution support, and National Contract Management support services. • Serves as a subject matter expert for other departments. • Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. • Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship. • Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. • Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. For example, such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding. • Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's). • Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include: administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.). • Trains other Provider Relations Representatives as appropriate. • Role requires 60%+ same-day or overnight travel. (Extent of same-day or overnight travel will depend on the specific Health Plan and its service area.) Job Qualifications REQUIRED EDUCATION: Bachelor's Degree in a healthcare related field or an equivalent combination of education and experience. REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: • 4-6 years provider contract network relations and management experience in a managed healthcare setting. • Working experience servicing complex providers with various managed healthcare provider compensation methodologies, including but not limited to: fee-for service, value-based contracts, capitation and various forms of risk, ASO, etc. PREFERRED EDUCATION: Master's Degree in Health or Business related field PREFERRED EXPERIENCE: • 5 years experience in managed healthcare administration. • Specific experience in provider services, operations, and/or contract negotiations in a Medicare and Medicaid managed healthcare setting, ideally with different provider types (e.g., physician, groups and hospitals). 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.

JOB DESCRIPTION Job SummaryProvides senior level support for medical records collection activities. Responsible for quality improvement activities including outreach to providers for collection of medical records for Healthcare Effectiveness Data and Information Set (HEDIS) specific data collection, projects and audit processes. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Outreaches to providers via phone call, fax, mail, electronic medical record system retrieval and direct on-site pick up for collection of medical records. • Loads medical records and reports from provider offices into the Healthcare Effectiveness Data and Information Set (HEDIS) application. • Provides subject matter expertise in project management/coordination of identification, pursuit and collection of medical records and other data in collaboration with other HEDIS staff. • Supports annual HEDIS audit and other like audits, and organizes provider outreach, pursuit, collection and upload of provider medical records into the internal database. Subject matter expert in the area of collecting medical records and reports from provider offices, loads data into the HEDIS application. • Assists the medical records leadership and quality improvement staff with physician and member interventions and incentive efforts as needed through review of medical records documentation. • Provides mentorship and leadership to team members and represents at a senior level for process and project improvement initiatives. • Participates in and prepares feedback for meetings with vendors related to the medical record collection process. • Some medical records collection related travel may be required. Required Qualifications• At least 2 years of health care experience, including medical records support experience in a managed care setting, or equivalent combination of relevant education and experience. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements. • Knowledge of Healthcare Effectiveness Data and Information Set (HEDIS) and National Committee for Quality Assurance (NCQA). • Proficiency with data analysis tools (e.g., Excel). • Ability to manage files, schedules and information efficiently. • Ability to effectively interface with staff, clinicians, and leadership. • Strong prioritization skills and detail orientation. • Strong verbal and written communication skills, including professional phone etiquette. • Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications • Registered Health Information Technician (RHIT). 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

Hourly Wage Estimate: 30.42 - 35.84 / hour Learn more about the benefits offered for this job. The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range. Introduction Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a Phlebotomy Laboratory Asst II today with Riverside Community Hospital. Benefits Riverside Community Hospital offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: * Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. * Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. * Free counseling services and resources for emotional, physical and financial wellbeing * 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) * Employee Stock Purchase Plan with 10% off HCA Healthcare stock * Family support through fertility and family building benefits with Progyny and adoption assistance. * Referral services for child, elder and pet care, home and auto repair, event planning and more * Consumer discounts through Abenity and Consumer Discounts * Retirement readiness, rollover assistance services and preferred banking partnerships * Education assistance (tuition, student loan, certification support, dependent scholarships) * Colleague recognition program * Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) * Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. Come join our team as a(an) Phlebotomy Laboratory Asst II. We care for our community! Just last year, HCA Healthcare and our colleagues donated 13.8 million dollars to charitable organizations. Apply Today! Job Summary and Qualifications Performs venipuncture and skin puncture; orders and restocks supplies; monitors computer orders; answers phones; greets patients, visitors, and employees; and performs other related clerical duties. What qualifications you will need: * High school diploma or equivalent * Current BLS Certification (renewable annually) * Certified Phlebotomist * State of California Certified Phlebotomy Technician for direct patient care contact positions * 1-year venipuncture experience in an acute hospital setting is preferred Riverside Community Hospital is a large acute care facility with 517 beds, established in 1901. It has the most extensive Emergency Room and Level I Trauma Center in the Inland Empire region and is the primary recipient of STEMI (heart attack) cases in Riverside County. The hospital is accredited as a Chest Pain Center and Comprehensive Stroke Center and has a HeartCare Institute that offers both invasive and non-invasive cardiac procedures. Riverside has a Level III Neonatal Intensive Care Unit, which it is very proud of. HCA Healthcare has been recognized as one of the Worlds Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses "The great hospitals will always put the patient and the patients family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Phlebotomy Laboratory Asst II opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

The Lead, Risk Adjustment - Predictive Analytics role supports Molina's Risk Adjustment Predictive Analytics team. Designs and develops Suspect, Targeting, and Tracking System to support Molina's Prospective and Retrospective Interventions. Provides technical, functional and business training to other team members to enable them to perform the tasks required. Knowledge/Skills/Abilities Assist Risk Adjustment Data Analytics Leaders in Prospective and Retrospective Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions. Design and development ad-hoc as well as automated analytical modules related to Risk Adjustment for Medicaid, Marketplace and Medicare/MMP. Assist Risk Adjustment Data Analytics Leaders in designing and developing Automated Suspect and Target/Ranking Engine for all line of businesses. Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and related financial data like risk score, revenue and cost. Conduct root cause analysis for business data issues, report to leadership the summary of findings and resolutions. Design and lead development of tracking system for risk scores for all intervention outcome and for overall markets and LOB. Work in an agile business environment to derive meaningful information out of complex as well as large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis. Work directly with interdepartmental / intradepartmental stakeholders along with Molina Executives to establish/deliver/explain the business requirement as well as data/data points and do necessary escalation as required. Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors. Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. Act as a subject matter expertise by following CMS/State regulations related to Risk adjustment Analytics and provide training as required. Stay current with industry regulation changes and educate the team and management as necessary. Track, Facilitate and Manage changes in the Datawarehouse platform and perform transparent upgrades to analytics reporting modules to ensure no impact to the end users. Conduct preliminary and post impact analyses for any logic and source code changes for data analytics and reporting module keeping other variables as constant that are not of focus. Develop training modules to help analysts understand processes, solutions or designs to meet the customer request for new/existing staff. Provide technical, functional and business training to other team members to enable them to perform the tasks required. Maintain a team culture to adopt fast faced agile environment and foster a positive attitude to take on challenging and time sensitive projects. Take accountability of tasks and projects assigned. Job Qualifications Required Education Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline. Required Experience 6+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data. 5+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design 5+ years of experience in working with Microsoft T-SQL, SSIS and SSRS. Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage. 5+ Years of experience in Analysis related to Risk Scores, Encounter Submissions, Payment Models for at least one line of business among Medicaid, Marketplace and Medicare/MMP. 5+ Years of experience in Prospective/Retrospective/Audit targeting Analytics and Reporting. 5+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. 5+ Years of experience in Statistical Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions PHYSICAL DEMANDS Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. • Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. • Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. • Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. • Assists in reviews of state and federal complaints related to claims. • Collaborates with other internal departments to determine appropriate resolution of claims issues. • Researches claims tracers, adjustments, and resubmissions of claims. • Adjudicates or readjudicates high volumes of claims in a timely manner. • Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. • Meets claims department quality and production standards. • Supports claims department initiatives to improve overall claims function efficiency. • Completes basic claims projects as assigned. Required Qualifications • At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. • Research and data analysis skills. • Organizational skills and attention to detail. •Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. • Customer service experience. • Effective verbal and written communication skills. • Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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

Knowledge/Skills/Abilities •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. •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 or related field or equivalent experience Required Experience 3-5 years experience supporting, designing and/or implementing application changes. Preferred Education Master's Degree Preferred Experience QNXT knowledge. SharePoint, MS Project 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.

* Board eligible or board certified in Gastroenterology * Must hold or be able to obtain an active California medical license prior to start * 1 office location * Inpatient practice setting * 1 week on/1 week off GI hospitalist role * There are also opportunities for academic involvement * Advanced endoscopy expertise is preferred but not required * GME teaching opportunities * GI fellowship support as first call/management of inpatient services Incentives/Benefits: * Extremely competitive compensation package * Ability to make over 900k if the incoming candidate works in the clinic on their off-weeks. * Relocation assistance * Generous PTO and CME allowance * Full benefits available including medical, dental, vision and short / long term disability * Leadership development * Personal career growth About Riverside Community Hospital: Located in the Greater Los Angeles area, Riverside Community Hospital has been a leader in the Inland Empire since 1901. The 542-bed acute care facility specializes in trauma, cancer care, neurosurgery, orthopedics, general surgery, cardiology, stroke intervention and so much more. By combining skilled caregivers with the latest state-of-the-art technology, Riverside Community Hospital delivers world-class healthcare close to home. Riverside Community Hospital is proud to have been named One of the Nation's Top 250 Hospitals three years in a row by Healthgrades. The facility has had multiple expansion projects to be able to continue to provide exceptional care to the community and is one of Riverside County's only STEMI receiving centers. Riverside Community Hospital is a fully accredited Chest Pain Center and DNV Comprehensive Stroke Center, encompassing the full spectrum of stroke care. The hospital is known for providing expert care in the following services: * Level I Trauma Center with helipad, providing access to higher acuity services for the surrounding rural communities up to 200 miles away * Complex and minimally invasive surgical services with robotics including general surgery, orthopedics, neurosurgery, cardiovascular and thoracic, colorectal, gynecology, urology * Comprehensive cardiac services including structural heart, electrophysiology and an advanced cardiogenic program * Extensive women's and children's services; including high-risk OB care and a Level III NICU * Certified joint replacement program and perinatal care program accredited by The Joint Commission * Multi-faceted oncology services with a full care team of specialists * Expert critical care units including surgical, cardiovascular, medical, neonatal and neuro intensive care units for higher level of care * Part of HCA Healthcare, a network of more than 185 hospitals and 2,000 sites of care in 21 states and the United Kingdom * 220 residents in fellows spanning a dozen specialties in HCA Healthcare's largest Graduate Medical Education program * A Top 50 Cardiovascular Hospital by Premier Inc. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role, as well as qualifications such as education, training, specialty, and/or experience, along with the geographic location where the work will be performed. Applicable to production-based provider roles only, the anticipated professional production including both quantity and/or quality may also play a role. For providers only, in no case shall compensation exceed fair market value. Riverside, California - located in Southern California and the most populous city in the Inland Empire, Riverside is just 55 miles east of downtown Los Angeles and a 55-minute drive to some of Southern California's most popular beaches. It is known as the birthplace of the California Citrus industry and home to both the famous Mission Inn Hotel and Spa and Mount Rubidoux, a popular attraction providing panoramic views of the city at its summit. Rich in history and outdoor adventures to discover, Riverside allows its residents to take full advantage of all that Southern California has to offer.