Molina Healthcare jobs in Vancouver, 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. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care. The SIU Investigator is also responsible for recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Officers in order to achieve and maintain appropriate anti-fraud oversight. Job Duties * Responsible for developing leads presented to the SIU to assess and determine whether potential fraud, waste, or abuse is corroborated by evidence. * Conducts both preliminary assessments of FWA allegations, and end to end full investigations, including but not limited to witness interviews, background checks, data analytics to identify outlier billing behavior, contract and program regulation research, provider and member education, findings identification and communications development, and recommendations and preparation of overpayment identifications and closure of investigative cases. * Completes investigations within the mandated period of time required by either state and/or federal contracts and/or regulations. * Conducts both on-site and desk top investigations. * Conducts low to medium, and extensive investigations, including reviews of medical records and data analysis, and makes determinations as to whether the investigation and/or audit identified potential fraud, waste, or abuse. * Coordinates with various internal customers (e.g., Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to gather documentation pertinent to investigations. * Detects potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns through utilization review. * Prepares appropriate FWA referrals to regulatory agencies and law enforcement. * Documents appropriately all case related information in the case management system in an accurate manner, including storage of case documentation following SIU related requirements. Prepares detailed preliminary and extensive investigation referrals to state and/or federal regulatory and/or law enforcement agencies when potential fraud, waste, or abuse is identified as required by regulatory and/or contract requirements. * Renders provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements. * Interacts with regulatory and/or law enforcement agencies regarding case investigations. * Prepares audit results letters to providers when overpayments are identified. * Works may be remote, in office, and on-site travel within the state of New York as needed. * Ensures compliance with applicable contractual requirements, and federal and state regulations. * Complies with SIU Policies as and procedures as well as goals set by SIU leadership. * Supports SIU in arbitrations, legal procedures, and settlements. * Actively participates in MFCU meetings and roundtables on FWA case development and referral JOB QUALIFICATIONS Required Education Bachelors degree or Associate's Degree, in criminal justice or equivalent combination of education and experience REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES * 1-3 years of experience, unless otherwise required by state contract * Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts from opinions. * Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations. * Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. * Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems. * Understanding of datamining and use of data analytics to detect fraud, waste, and abuse. * Proven ability to research and interpret regulatory requirements. * Effective interpersonal skills and customer service focus; ability to interact with individuals at all levels. * Excellent oral and written communication skills; presentation skills with ability to create and deliver training, informational and other types of programs. * Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook), SharePoint and Intra/Internet as well as proficiency with incorporating/merging documents from various applications. * Strong logical, analytical, critical thinking and problem-solving skills. * Initiative, excellent follow-through, persistence in locating and securing needed information. * Fundamental understanding of audits and corrective actions. * Ability to multi-task and operate effectively across geographic and functional boundaries. * Detail-oriented, self-motivated, able to meet tight deadlines. * Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities. * Energetic and forward thinking with high ethical standards and a professional image. * Collaborative and team-oriented REQUIRED LICENSE, CERTIFICATION, ASSOCIATION: * Valid driver's license required. PREFERRED EXPERIENCE: At least 5 years of experience in FWA or related work. PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: * Health Care Anti-Fraud Associate (HCAFA). * Accredited Health Care Fraud Investigator (AHFI). * Certified Fraud Examiner (CFE). To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.82 - $51.06 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Provides support for Molina Healthcare's Protection Services Operations Center (PSOC) by conducting daily investigations activities and ensuring enterprise-wide compliance. Reporting to the Manager, Investigations, this role supports employees, handles incident response, and escalates cases involving Molina facilities or interests as needed. Collaborates closely with PSOC partners, Human Resources, Legal, and other stakeholders to support both routine and complex investigations and helps develop tools and processes that meet evolving business needs. Job Duties * Engages in high-stress situations to ensure incident response, threat mitigation, and after-care support for involved workforce members and/or company facilities. * Rapidly responds (in a remote environment) to workforce members involved in workplace violence incidents, threat events, and distressed situations. * With minimal oversight, independently leads or provides support to investigations including: * Collects physical or digital evidence and performs detailed analysis * Conducts and accurately documents interviews * Creates, updates and maintains case management records and systems * Prepares comprehensive, timely, and detailed professional incident reports on all inquiries regarding potential and/or actual investigative matters, including presentations on research findings and necessary recommendations. * Establishes, maintains and promotes successful relationships with law enforcement agencies in all jurisdictions with Molina business/employee interests. * Conducts comprehensive Open-Source Intelligence (OSINT) supporting investigative or threat management initiatives. * Supports Threat Intelligence to include conducting employee safety assessments during situational or environmental responses. * Develops and conducts employee awareness training in security focused areas of responsibility. * May be required to work outside of normal business hours (nights, evenings, and weekends) if responding to emergent investigations or employee welfare concerns. * Coordinates dispatch security personnel to respond to incidents. Coordinates and issues alerts (i.e., BOLO) * Other duties as assigned by management Job Qualifications Required Qualifications: * At least 2 years of corporate business experience in physical security, investigations, or law enforcement, or equivalent combination of relevant education and experience. * Experience in investigative interviewing techniques. * Exceptional written communication, interpersonal, analytical, and research skills with strong case management expertise. * Naturally curious and enjoys learning new things. * Ability to engage in several tasks at once. * Self-motivated and results oriented. * A problem solver and an analytical thinker. * Superb organizational skills and the ability to delegate effectively to meet delivery targets. * Ability to interact concisely/accurately and positively with leadership and colleagues * Action oriented and driven to achieve results in a positive manner, displaying ethical behavior and integrity. * Strong grasp and hands-on experience in physical security. * Situational awareness and responding to incidents involving employee and property threats. * Experience with creation of metrics, reporting and analysis. * Familiarity with best practices and standards and experience with industry standard tools and concepts. Preferred Qualifications: * Experience in an operations center preferred 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: $21.82 - $51.06 / 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.

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 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. $37,440 - $43,800 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.

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 MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live in the designated territory to effectively serve their local community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll help bring Humana's strategy to life: Deliver on the fundamentals, differentiate through exceptional service, and grow by expanding our reach and impact. What You'll Do in This FIELD Based Role: * Deliver: Build trust and educate individuals on Humana's Medicare Advantage plans and additional offerings like Life, Dental, Vision, and Prescription coverage. * Differentiate: Create meaningful, face-to-face connections through grassroots marketing, community events, and in-home visits-providing a personalized experience that sets Humana apart. * Grow: Drive self-generated sales, meet performance goals, and expand Humana's presence in the market by becoming a valued resource in your community. You'll engage with customers in the FIELD through a mix of in-person, virtual, and phone interactions. Face-to-face visits in prospective members' homes are a key part of this role. Why Join Humana? * People-first culture that supports your personal and professional growth. * Inclusive and diverse environment that values multilingual talent and cultural understanding. * Autonomy and flexibility to manage your schedule and success. * Purpose-driven mission to help people achieve their best health-and transform healthcare along the way. Benefits include: * Medical, Dental, Vision, and a variety of other supplemental insurances * Paid Time Off (PTO) and Paid Holidays * 401(k) retirement savings plan with a competitive match * Tuition reimbursement and/or scholarships for qualifying dependent children * And much more! Use your skills to make an impact Required Qualifications * Active Health Insurance License or ability to obtain. * Must reside in the designated local territory to effectively serve the community. * Comfortable with daily face-to-face interactions in prospective members' homes and engaging with the community through service, organizations, volunteer work, or local events. * Valid state driver's license and proof of personal vehicle liability insurance meeting at least 25/25/10 coverage limits (or higher, based on state requirements). Preferred Qualifications * Active Life and Variable Annuity Insurance License. * Prior experience selling Medicare products. * Experience in public speaking or delivering presentations to groups. * Associate's or Bachelor's degree. * Experience using Microsoft Office tools such as Teams, Excel, Word, and PowerPoint. * Bilingual in English and Spanish, with the ability to speak, read, and write fluently in both languages. Additional Information * This position is in scope of Humana's Driving Safety and Vehicle Management Program and therefore subject to driver license validation and MVR review. * 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. * 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. Schedule: Meeting with members requires appointments and/or event times that may vary on nights and weekends. Flexibility is essential to your success. Training: The first five weeks of employment and attendance is mandatory. Interview Format: As part of our hiring process for this opportunity, we are using an 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 to move forward in the process, you will receive a text message inviting you to participate in a HireVue prescreen. In this prescreen, you will receive a set of questions via text and given the opportunity to respond to each question. You should anticipate this prescreen taking about 15 minutes. Your responses will be reviewed and if selected to move forward, you will be contacted with additional details involving the next step in the process. Pay Range The range below reflects a good faith estimate of total compensation for full time (40 hours per week) employment at the time of posting. This compensation package includes both base pay and commission with guarantee. The pay range may be higher or lower based on geographic location. Actual earnings will vary based on individual performance, with the base salary and commission structure aligned to company policies and applicable pay transparency requirements. $80,000 - $125,000 per year #medicaresalesrep Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 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.

Become a part of our caring community and help us put health first The Medical Social Worker participates in the interdisciplinary care provided to home health patients. The Medical Social Worker functions to evaluate and develop a plan of care personalized to fit the patient's emotional and social needs. The Medical Social Worker provides direction and supervision of the Social Worker Assistant as required and when involved in the patient's plan of care. The Medical Social Worker works within CenterWell Home Health's company-specific policy and procedures, applicable healthcare standards, governmental laws, and regulations. * Assesses the patient's social and emotional state as it relates to his or her illness or injury, needs for care and his or her response to such treatment, and adjustments to care. * Assesses any relationships of the patient's medical and nursing needs in the home setting, financial resources, and available community resources. * Provides any appropriate action to obtain available community resources to assist in resolving issues that may be impeding the patient's recovery. * Instructs patients and families in treating and coping with social and emotional response connected with Provides ongoing assessment of patient and family needs and responses to teaching * Assists the physician and other health team members in understanding the significant social and emotional factors related to the patient's health Participates in the development and periodic re-evaluation of the physician's Plan of Care for the patient. * Observes, records, and reports changes in patients' condition and response to treatment to the Clinical Manager and the Participates in the discharge planning process * Participates as a member of the interdisciplinary care team in care coordination activities and acts as a resource to other health team members in the identification and resolution of patient needs * Supervises instructs and evaluates the performance of the Social Work Assistant (BSW) to assure that all medical social services are provided to patients in compliance with Company, government, and professional standards * Maintains and submits documentation as required by the company and/ or facility including any case conferences, patient/physician community contacts, visit reports progress notes, and confers with other health care disciplines in providing optimum patient care. Use your skills to make an impact Required Skills/Experience * Masters or doctoral degree from a school of social work accredited by the Council on Social Work Education. * Social Worker licensure in the state of practice; if required by state law or regulation. * A valid driver's license, auto insurance, and reliable transportation are required. * Proof of current CPR certification * Minimum of one year of experience as a social worker in a health care setting, home health, and/or hospice. * Knowledge of and the ability to assist with discharge planning needs, and to obtain community resources (housing, shelter, funeral/memorial service arrangements, legal, information and referral, state/federal financial and medication programs, and eligibility. * Excellent oral and written communication and interpersonal skills. 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. $48,900 - $66,200 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.

Candidates must be located in California and work PST hours. Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. KNOWLEDGE/SKILLS/ABILITIES * Develops, implements, and uses software and systems to support the department's goals. * Develops and generates ad-hoc and standard reports using SQL programming, excel , Databricks and other analytic / programming tools. * Coordinates and oversees report generation by team members and distribution schedule to ensure timely delivery to customers, ensuring the highest quality on every project/request. Responsible for error resolution, follow up and performance metrics monitoring. * Provides peer review of critical reports and guidance on programming / logic improvements; provides guidance to team members in their analysis of data sets and trends using statistical tools and techniques to determine significance and relevance. * Applies process improvements for the team's methods of collecting and documenting report / programming requirements from requestors to ensure appropriate creation of reports and analyses while reducing rework. * Manage the creation of comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures. * Create new databases and reporting tools for monitoring, tracking, and trending based on project specifications. * Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures. * Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. * Maintains SharePoint Sites as needed, including training materials and documentation archives. * Demonstrate Healthcare experience in contract modeling, analyzing relevant Financial and Utilization Metrics of Healthcare. * Must be able to act as a liaison between Finance and Network Contracting as well as other external teams. * Must have experience in Financial modeling, identifying Utilization mgmt. trends and monitor pair mix. * Experience with Medicaid contract analytics is highly preferred. * Experience working on Managed care analytics and healthcare reimbursement models is required. * Must be able to work in a cross functional team. JOB QUALIFICATIONS Required Education Bachelor's Degree in Finance, Economics, Computer Science Required Experience * 6+ years of progressive responsibilities in Data, Finance or Systems Analysis * Expert knowledge on SQL, PowerBI, Excel, Databricks or similar tools Preferred Education Bachelor's Degree in Finance, Economics, Math, Accounting or related fields Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators: * Proactively identify and investigate complex suspect areas regarding contract rate and related medical costs * Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan * Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, etc. * Analysis of trends in medical costs to provide analytic support for finance, pricing, and actuarial functions * Multiple data systems and models * BI tools (Power BI) Preferred License, Certification, Association QNXT or similar healthcare payer applications To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $171,058 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

We are seeking a Senior AI Developer/Engineer to lead the design and deployment of intelligent conversational agents across IT, HR, and enterprise platforms. * Develop and implement AI-driven virtual assistants using Moveworks, Oracle GenAI Agents, and Microsoft Azure AI Copilot. * Design conversational flows, intents, and memory for multi-turn interactions. * Integrate AI agents with enterprise systems like ServiceNow, Oracle HCM, and Microsoft Teams. * Create custom agent workflows and automation using APIs and low-code tools. * Apply prompt engineering and fine-tune LLMs to ensure accuracy and tone alignment. * Implement testing frameworks, QA processes, and user acceptance validation. * Manage deployments, monitor performance, and ensure secure data handling. * Continuously enhance AI agent capabilities using platform updates and analytics insights. * Document architectures, workflows, and operational procedures. * Ensure compliance with AI governance, data privacy, and responsible AI principles. * Collaborate with cross-functional teams across IT, HR, and AI governance committees. * Mentor developers and promote best practices in AI development. * Stay current with new Moveworks and Azure AI features for enterprise automation. * Strong skills in Python, REST APIs, OAuth 2.0, and enterprise integrations required. * Ideal candidate has experience with LLMs, chatbots, and secure cloud AI deployment. JOB QUALIFICATIONS REQUIRED EDUCATION: Bachelor's Degree in Business Administration or Information Technology or equivalent combination of education and experience REQUIRED EXPERIENCE: 5-7 years related experience in a combination of applicable business and business systems REQUIRED LICENSE, CERTIFICATION, ASSOCIATION: PREFERRED EDUCATION: PREFERRED EXPERIENCE: PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: STATE SPECIFIC REQUIREMENTS: To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $117,000 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

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. 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.

Molina Medicare Stars Program Manager functions oversees, plans and implements new and existing health care quality improvement initiatives and education programs. Responsible for Medicare Stars projects and programs involving enterprise, department or cross-functional teams of subject matter experts, delivering impactful initiatives through the design process to completion and outcomes measurement. Monitors the programs and initiatives from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management for Stars Program and Quality Improvement activities. Job Duties * Collaborates with teams & health plans impacted by Medicare Quality Improvement programs involving enterprise, department or cross-functional teams of subject matter experts, delivering products through the design process to completion. * Supports Stars program execution and governance needs to communicate, measure outcomes and develop initiatives to improve Star Ratings * Plans and directs schedules Program initiatives, as well as project budgets. * Monitors the project from inception through delivery and outcomes measurement. * May engage and oversee the work of external vendors. * Focuses on process improvement, organizational change management, program management and other processes relative to the Medicare Stars Program * Leads and manages team in planning and executing Star Ratings strategies & programs. * Serves as the Medicare Stars subject matter expert in the functional area and leads programs to meet critical needs. * Communicates and collaborates with health plans to analyze and transform needs and goals into functional requirements. * Delivers the appropriate artifacts as needed. * Works with Enterprise and Health Plan l leaders within the business to provide recommendations on opportunities for process improvements. * Monitors and tracks key performance indicators, programs and initiatives to reflect the value and effectiveness of Stars and Quality improvement programs * Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations. * Generate and distribute standard reports on schedule Job Qualifications REQUIRED EDUCATION: Bachelor's Degree or equivalent combination of education and experience. REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: * 3-5 years of Medicare Stars Program and Project management experience. * Demonstrated knowledge of and experience with Star Ratings & Quality Improvement programs * Operational Process Improvement experience. * Medicare experience. * Experience with Microsoft Project and Visio. * Excellent presentation and communication skills. * Experience partnering with different levels of leadership across the organization. PREFERRED EDUCATION: Graduate Degree or equivalent combination of education and experience. PREFERRED EXPERIENCE: * 5-7 years of Medicare Stars Program and/or Project management experience. * Managed Care experience. * Experience working in a cross functional highly matrixed organization. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $171,058 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Become a part of our caring community and help us put health first As a therapist at CenterWell Home Health, you'll play a vital role in helping patients regain strength, mobility and independence-all from the comfort of their homes. By delivering personalized care that focuses on rehabilitation and functional improvement, you'll empower individuals to overcome physical limitations, perform everyday activities with confidence and enjoy a better quality of life. As a Home Health Speech Language Pathologist, you will: * Evaluate, direct and provide speech/language pathology service to patients in the home or facility * Participate in the development and periodic review of the Plan of Treatment and Plan of Care. * Utilize professional skills and judgment in assessing and treating disorders of speech, voice, language, hearing and swallowing to prevent, identify, evaluate and minimize the effects of such disorders and conditions. * Administer and interpret diagnostic tests and applications of therapeutic treatments including audio logic screening. * Observe, record and report changes in the patient's condition and response to treatment to supervisor and/or the physician. * Provide instruction and training to patients in use of alternative communication systems when appropriate. * Provide counsel and instruction to patients, families and healthcare staff. * Maintain and submit documentation as required by the Company and/or facility. Prepare and submit timely written reports of evaluations, visits, summaries, care plans, care coordination activities and progress reports as required by Company policy. * Participate in care coordination activities and discharge planning. * Maintain the highest standards of professional conduct in relation to information that is confidential in nature. Share information only when the recipient's right to access is clearly established and the sharing of such information is clearly in the best interests of the patient. * Attend, participate in and/or conduct internal staff development programs, obtain continuing education as required by Company policy, regulation. Use your skills to make an impact Required Experience/Skills: * Meet the education and experience requirements for Certification of Clinical Competence in Speech Language Pathology or Audiology granted by ASHA * Minimum of six months experience as a speech therapist / speech language pathologist * Home Health experience a plus * Current and unrestricted license * Current CPR certification * Good organizational and communication skills * A valid driver's license, auto insurance, and reliable transportation are required. Pay Range * $58.00 - $81.00 - pay per visit/unit * $84,900 - $116,800 per year base pay Scheduled Weekly Hours 1 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $84,900 - $116,800 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident. About Us About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

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.

Schedule: Monday - Friday; 8:00am - 5:00pm Introduction Do you want to join an organization that invests in you as a Medicaid Eligibility Advocate? At Willamette Valley Medical Center, you come first. HCA Healthcare has committed up to 300 million in programs to support our incredible team members over the course of three years. Benefits Parallon offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: * Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. * Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. * Free counseling services and resources for emotional, physical and financial wellbeing * 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) * Employee Stock Purchase Plan with 10% off HCA Healthcare stock * Family support through fertility and family building benefits with Progyny and adoption assistance. * Referral services for child, elder and pet care, home and auto repair, event planning and more * Consumer discounts through Abenity and Consumer Discounts * Retirement readiness, rollover assistance services and preferred banking partnerships * Education assistance (tuition, student loan, certification support, dependent scholarships) * Colleague recognition program * Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) * Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated Medicaid Eligibility Advocate like you to be a part of our team. Job Summary and Qualifications The Medicaid Eligibility Advocate is responsible for conducting eligibility screenings, assessment of patient financial requirements, and counseling patients on insurance benefits and co-payments. The Medicaid Eligibility Advocate is a liaison between the patient, hospital, and governmental agencies and is actively involved in all case management areas. In this role you will: * Screen and evaluate patients for existing insurance coverage, federal and state assistance programs, or hospital charity applications. * Re-verifies benefits and obtains authorization and/or referral after treatment plan has been discussed, prior to initiation of treatment. Ensures appropriate signatures are obtained on all necessary forms. * Obtain legally relevant medical evidence, physician statements and all other documentation required for eligibility determination. * Complete and file applications. Initiate and maintain proper follow-up with the patient and government agency caseworkers to ensure timely processing and completion of all mandated applications and accompanying documentation. * Ensure all insurance, demographic and eligibility information is obtained and entered into the system accurately. Document progress notes to the patient's file and the hospital computer system. * Participates in ongoing, comprehensive training programs as required. * Follows policies and procedures to contribute to the efficiency of the office. Covers and assists with other office functions as requested. * Will be required to make field visits as necessary and will need reliable personal transportation readily available. Qualifications: * Associate degree preferred * Minimum of one-year related experience preferred, preferably in healthcare. * Relevant education may substitute experience requirement. " Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. " "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Medicaid Eligibility Advocate opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data within multiple claims systems and validates data stored within provider databases - ensuring adherence to business and system requirements as it pertains to contracting, network management and credentialing. Essential Job Duties * Receives provider information from outside parties for loading/update in internal computer systems and databases; analyzes information and applies knowledge, experience, attention to detail and accuracy to ensure appropriate information has been provided and entry is completed timely and accordance with department standards related to turnaround times and quality. * Maintains department standard for loading provider demographic data including affiliation and contract assignment. * Audits loaded provider records for quality and financial accuracy, and provides documented feedback. * Ensures that provider information is loaded accurately to ensure proper claims processing, outbound reporting and directory processes. Required Qualifications * At least 1 year of experience in health care, preferably in a customer/provider services setting, or equivalent combination of relevant education and experience. * Critical-thinking skills, and attention to detail. * Organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite (including Excel) and applicable software program(s) proficiency. Preferred Qualifications 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. 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.

Provides entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties * Enters denials and requests for appeals into information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances. * Elevates appropriate appeals to the next level for review. * Generates and mails denial letters. * Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. Required Qualifications * At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. * Customer service experience. * Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. * Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). 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 - $34.88 / 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.

JOB DESCRIPTION Job SummaryProvides support for pharmacy Medication Therapy Management (MTM) activities. Contributes to overarching pharmacy strategy to ensure member access to medically necessary prescription drugs, optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job Duties * Collaborates with pharmacists on medication adherence and provides follow-up on identified adherence barriers. * Performs outreach to members, prescribers and/or pharmacies as needed. * Participates in the development/administration of pharmacy programs designed to enhance the utilization of targeted drugs and identification of cost-saving pharmacy practices. * Identifies and reports pharmacy operational issues and resource needs to appropriate leadership. * Assists Molina member services, pharmacies, and health plan providers in resolution of member prescription claim, prior authorization, and pharmacy service access issues. * Articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed. Required Qualifications * At least 2 years pharmacy technician experience, preferably supporting Medication Therapy Management (MTM), or equivalent combination of relevant education and experience. * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers. * Ability to abide by Molina policies. * Ability to maintain attendance to support required quality and quantity of work. * Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA). * Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers. * Excellent verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software program(s) proficiency. Preferred Qualifications * Medication Therapy Management (MTM) 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 - $31.71 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Manages people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management, rather than the application of expertise in a specialized functional field of knowledge although they may have technical team members. **Expanded Scope:** The Senior Project Manager for Claims Operations drives complex, multi-workstream initiatives that span people, process, data, and technology. Key areas include: + Strategy & Road mapping: Translate business strategy into a prioritized project roadmap; define scope, OKRs/KPIs, value hypothesis, and measurable success criteria (e.g., first-pass resolution, auto-adjudication rate, claims cycle time, audit findings, cost-to-serve). + Process Optimization: Lead current/future-state mapping, root cause analysis, and continuous improvement (Lean/Six Sigma). Design scalable workflows and controls across intake, adjudication, adjustments, appeals/grievances, and payment integrity. + Technology Enablement: Oversee requirements, configuration, and testing for platforms such as Salesforce (case management, integrations), QNXT (or similar core claims), RPA/automation, and analytics/reporting (e.g., SQL/Excel, BI tools). + Delivery Excellence: Plan and execute across Waterfall/Agile or hybrid approaches; lead UAT, cutover, and post-go‑live; steward change management (training, SOPs, job aids, communications). + Risk, Compliance & Quality: Ensure alignment to CMS, HIPAA, state regulations, and audit readiness. Establish governance, RAID (risks/assumptions/issues/dependencies), and quality gates throughout delivery. + Vendor & Stakeholder Management: Manage SOWs and partner performance; facilitate executive steering, operational readiness, town halls, and cross-functional standups. + People Leadership & Culture: Model a high-performance, collaborative culture; mentor PMs/analysts; promote data-driven decision making and continuous improvement. **KNOWLEDGE/SKILLS/ABILITIES** + **Project & Portfolio Leadership** + Leads high dollar, multi-workstream programs; sets cadence (steering committees, status reports, dashboards), manages budget, resources, and critical path. + Balances capacity across initiatives; aligns with PMO standards, stage gates, and financial controls. + **Operational & Regulatory Acumen (Healthcare/Claims)** + Deep understanding of claims lifecycle, EDI transactions, payment integrity, provider data, appeals/grievances, and audit/compliance (CMS, HIPAA, NCQA, state regs). + Designs and embeds controls, SLAs, and quality checks to support audit readiness and reduce rework. + **Process Improvement & Change Management** + Applies Lean/Six Sigma for waste reduction and throughput gains + Executes structured change management including stakeholder engagement, training plans, SOPs/job aids, and communications. + **Technical Fluency & Data Literacy** + Translates business needs into requirements and test cases; manages integrations across Salesforce, core claims (e.g., QNXT), and data pipelines. + Builds and interprets KPI dashboards; uses SQL/Excel or BI tools to analyze performance and inform decisions. + **Communication & Influence** + Crafts clear exec-ready updates, risk narratives, and decision papers; negotiates tradeoffs; escalates with options and quantified impacts. + Facilitates across operational, clinical, compliance, finance, and IT stakeholders. + **Execution Excellence** + Strong organization, prioritization, and time management in fast-paced environments; anticipates dependency and adoption risks; drives on-time, on-budget delivery. **Tools/Methods (examples):** Salesforce, QNXT (or similar core claims), JIRA/Azure DevOps, MS Project/Smartsheet, Visio/Miro/Lucid, SQL, Excel, PowerPoint, Power BI/Tableau, Confluence, ServiceNow; Lean/Six Sigma; Agile/Waterfall/Hybrid. **JOB QUALIFICATIONS** **Required Education** + Bachelor's Degree or equivalent combination of education and experience **Required Experience** + 5-7 years of project/program management with direct impact on Claims Operations (adjudication, configuration, appeals/grievances, payment integrity, provider data). **Preferred Education** + Graduate Degree or equivalent combination of education and experience + Formal training/coursework in project management, process improvement, change management, or healthcare operations. + Specialized training in Salesforce administration, process mapping, UAT/QA, or data analytics. **Preferred Experience** + 7-9 years of project/program management with direct impact on Claims Operations (adjudication, configuration, appeals/grievances, payment integrity, provider data). + Proven leadership of multi-vendor, multi-system implementations (e.g., Salesforce + claims core + data/BI) with hybrid Agile/Waterfall delivery. + Track record in process mapping, workflow redesign, automation (RPA/integration), and control design to improve accuracy and cycle times. + Experience creating and delivering training, SOPs, job aids, and communications; leading readiness, cutover planning, and post-go live stabilization. + Hands-on governance, quality assurance, risk management, and escalation handling in a regulated environment (CMS, HIPAA, state). + Proficiency with Salesforce, QNXT (or similar), SQL, Excel, JIRA/Azure DevOps, and PM/visualization tools (MS Project/Smartsheet, Power BI/Tableau). + Experience facilitating high-visibility forums (executive steering, town halls, implementation readiness reviews); prior people leadership or mentoring of PMs/analysts is a plus. + Strong analytical, organizational, and communication skills; adept at managing multiple priorities and influencing across levels. **Preferred License, Certification, Association** + PMP (Project Management Professional) strongly preferred. + Lean Six Sigma Black Belt preferred (Green Belt considered). + Agile/Scrum certification (e.g., CSM, PMI-ACP, SAFe) desirable. + Salesforce Administrator or relevant platform certification a plus. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Become a part of our caring community and help us put health first Make a meaningful impact every day as a CenterWell Home Health nurse. You'll provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working closely with a dedicated team of physicians and clinicians, you'll develop and manage care plans that support recovery and help patients get back to the life they love. As a Home Health Registered Nurse, you will: * Provide admission, case management, and follow-up skilled nursing visits for home health patients. * Administer on-going care and case management for each patient, provide necessary follow-up as directed by the Clinical Manager. * Confer with physician in developing the initial plan of treatment based on physician's orders and initial patient assessment. Provide hands-on care, management and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision. Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation. * Coordinate appropriate care, encompassing various healthcare personnel (such as Physical Therapists, Occupational Therapists, Home Health Aides and external providers). * Report patient care/condition/progress to patient's physician and Clinical Manager on a continuous basis. * Implement patient care plan in conjunction with patient and family to assist them in achieving optimal resolution of needs/problems. * Coordinate/oversee/supervise the work of Home Health Aides, Certified Home Health Aides and Personal Care Workers and provides written personal care instructions/care plan that reflect current plan of care. Monitor the appropriate completion of documentation by home health aides/personal care workers as part of the supervisory/leadership responsibility. * Discharge patients after consultation with the physician and Clinical Manager, preparing and completing needed clinical documentation. * Prepare appropriate medical documentation on all patients, including any case conferences, patient contacts, medication order changes, re-certifications, progress updates, and care plan changes. Prepare visit/shift reports, updates/summarizes patient records, and confers with other health care disciplines in providing optimum patient care. Use your skills to make an impact Required Experience/Skills: * Diploma, Associate or Bachelor Degree in Nursing * Minimum of one year nursing experience preferred * Strong med surg, ICU, ER, acute experience * Home Health experience a plus * Current and unrestricted Registered Nurse licensure * Current CPR certification * Strong organizational and communication skills * Valid driver's license, auto insurance and reliable transportation. Pay Range * $55.00 - $76.00 - pay per visit/unit * $80,400 - $110,500 per year base pay Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $80,400 - $110,500 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.

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 24 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. $37,440 - $43,800 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.