Presbyterian Jobs
- 1,240 JobsAVP, Health Plan Quality Improvement (Remote in Nebraska)
Planning and implementing evidence-based quality intervention strategies and initiatives that meet state and federal intervention rules and are aligned with effective practices as identified in the healthcare quality improvement literature and within Molina strategic plans. Serving as operations and implementation lead for Molina plan quality improvement activities using a defined Communicating with the Plan President, Molina Plan Senior Leadership Team, Chief Medical Officer, $122.4k-238.7k yearly7d agoUM Nurse (remote must reside in Iowa)
Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. $26.4-51.5 hourly19d agoSr. Analyst, Healthcare (SQL / Provider Network Verification - Remote in Florida
Knowledge/Skills/Abilities + Research and analyze Provider Network State File. + Oversees development, organization, and ongoing maintenance of data representing a wide range of Provider information. + Develops and directs a process to clean and integrate complex healthcare datasets in order to create the data foundation for further analytics and the development of key insights. + Supervises completion of special projects as requested, by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. + Oversees, establishes, and maintains timelines for reports and projects. + Ensures quality of output by submitting work product for quality checks and reviews and performing similar functions for other staff. Job Qualifications Required Education Associate Degree or equivalent combination of education and experience Required Experience 3-5 years systems analysis experience. Preferred Education Bachelor's Degree or equivalent combination of education and experience Preferred Experience 5-7 years systems analysis experience. Experience writing SQL queries. Knowledge / experience of Florida State Provider Network Verification File (PNV). QNXT knowledge. Expertise with Excel and Power BI. Medicaid experience. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $49,929.54 - $97,362.61 a year* *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. #PJHPO #LI-BEMORE $49.9k-97.4k yearly46d agoRemote Family Nurse Practitioner (Hybrid-Tele/Field Visits)
The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, community, and nursing facility settings. Provides needed care in the environment that patients feel most comfortable and are most receptive including home, nursing facilities, and “pop up” clinic. The Nurse Practitioner will be required to work primarily in non-clinical settings and provide medical care to all levels of patients. Some programs may focus on specific populations (e.g., adult and geriatric, pediatric, women's health). Perform comprehensive medical assessments, order appropriate tests/procedures for diagnostic purposes, formulate treatment plans, obtain specialists' consultations as needed, and do appropriate documentations as required. Provide general medical care to various and/or specific patient levels - adults and geriatric. Perform comprehensive evaluations including history and physical exams for risk adjustment and other regulatory assessments Address both chronic and acute primary care complaints, and able to ascertain medical urgency Establish and document reasonable medical diagnoses Seek specialty consultation as appropriate Order pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptom; able to work within an environment of limited resources and therefore uses diagnostic tests judiciously and appropriately Discuss unusual or unclear symptoms or results with consulting physician in a timely manner Accept feedback and direction from the supervising physician Create and implements a medical plan of care Provides care coordination and preventative care services for geographical as well as virtual targets who are stratified by risk. Schedule patient appointments for telehealth or in-person visits when appropriate Provide post discharge coordination to reduce hospital readmission rates and emergency room utilization Perform diagnostic and/or therapeutic procedures within his/her level of training and expertise, and as outlined on the practice agreement and written protocol with the supervising physician Perform face-to-face in-person visits in a variety of settings including home, skilled nursing facilities, and public locations. Additionally, perform face-to-face synchronous video communications using Telehealth platform based on business need and leadership direction Order bulk laboratory orders to target specific populations of member. Perform alternating on-call coverage to triage any urgent lab results and develop appropriate plan of care Participate in community-based “Pop Up Clinics” as way of building relationship with community while addressing gaps in health care Drive up to 120 miles a day on a regular basis. There may be drives beyond 120 miles as part of Extended Mileage Special Project days. Obtain cross state license in other states besides home state based on business need. Collaborate with fellow nurse practitioners to develop best practices to efficiently and effectively carry out work duties Actively participate in regional meetings Prescribe medications as appropriate Remain knowledgeable on current therapies Perform timely documentation in medical records in an electronic medical record computer system Engage in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician to the degree required by state laws. May also function as and perform all duties reasonably expected and assigned to an RN such medication administration. Work as a partner with supervising physician. The NP is responsible for initiating collaboration, as it is needed. The NP is responsible for knowing when a patient needs physician oversight and when the patient's medical condition may be beyond the scope of knowledge of the NP. JOB QUALIFICATIONS Master's degree in family health from accredited nursing program REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: Experience in chronic disease management and preventative care REQUIRED LICENSE, CERTIFICATION, ASSOCIATION: Completion of Nurse Practitioner program at the master's level, with an active and unrestricted national certification from one of the following organizations: American Academy of Nurse Practitioners; American Nurses Credentialing Center Current state-issued license to practice as a Family Nurse Practitioner Current Basic Life Support for Healthcare Professional certification Current unrestricted driver's license PREFERRED EXPERIENCE: 3-5-year experience as a Registered Nurse and/or Nurse Practitioner, ideally in a home health, community health, or public health setting Previous experience in home health as a licensed clinician, especially in management of chronic conditions Experience with underserved populations facing socioeconomic barriers to health care Fluency in a language in addition to English is plus Immunization and phlebotomy skills Pay Range: $73,101.84 - $142,548.59 a year* *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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. $73.1k-142.5k yearly1d agoSr Specialist, Delegation Oversight (Claims)- REMOTE - CA ONLY
Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with DMHC and DHCS requirements including delegation standards and requirements contained in the Molina Medical Compliance and Fraud, Waste and Abuse Program. This position is in California and is in Claims. KNOWLEDGE/SKILLS/ABILITIES Coordinates, conducts, and documents delegation assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements. Prepares status reports from Delegated Entities. Develops corrective action plans when deficiencies are identified, and documents follow-up to completion. Ensures compliance with reporting requirements by tracking the receipt and completeness of reports. Develops corrective action plans when compliance issues are identified, and document follow-up to completion. Assists with meetings of the Delegation Oversight Committee, including the preparation of documents for committee oversight of delegated functions. Works with Network Management team to develop and maintain delegation agreements and assessment tools. Prepares delegation oversight document evidence for state monitoring visits and NCQA accreditation surveys and participates on Molina's work team. JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent combination of education and experience. Required Experience 3+ years managed care experience. Min. 1 year experience completing delegation oversight assessment/ audits. Data analysis experience. Required License, Certification, Association Valid State Driver's License Preferred Education Bachelor's Degree in Business or Health Care related field. Preferred Experience 5 years managed care experience. 2 years' experience completing delegation oversight assessments/audits. Quality management/regulatory experience with increasing responsibility. 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. #PJHPO #Li-BeMore Pay Range: $45,390.49 - $88,511.46 a year* *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. $45.4k-88.5k yearly16d agoSr Rep, Enrollment - Remote (Must reside in NYC)
Quality review and submission of deliverables to Molina Healthcare Government Contract and to State Medicaid Agencies. $14.9-29.1 hourly22d agoExecutive Assistant (Remote - Candidate must reside in the Midvale, UT area)
Remote role with in office (Midvale, UT) days as needed. Ideal Candidate will reside in the Midvale, UT. $21.8-42.6 hourly36d agoRemote Care Coordinator I - Community Health Worker ABQ NM Area
Join our team as a Care Coordinator I - Community Health Worker! As a Care Coordinator I - Community Health Worker, you will participant of the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Presbyterian employees gain access to a robus $29k-37k yearly est.22h agoRemote Care Coordinator I - Community Health Worker Socorro, NM area
Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more! As a Care Coordinator I - Community Health Worker, you will participant of the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Join our team as a Care Coordinator I - Community Health Worker! From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. Presbyterian's story is really the story of t $29k-37k yearly est.18h agoRemote PRN IP Facility Coder III CCS
From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. Presbyterian's story is really the story of the remarkable people who choose to work here. Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more! The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New M $22.4-34.3 hourly18h agoRemote CCS Inpatient Facility Coder
Presbyterian's story is really the story of the remarkable people who choose to work here. Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more! From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. Now hiring a Remote CCS Inpatient Facility Coder! The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans. $22.4-34 hourly5d agoCall Center Representative-Patient Services-Work At Home
Conducts outbound calls as required and meets established quality/quantity guidelines supporting PHS/PHP/PMG initiatives and/or programs. High school diploma plus one to three years office/business experience; call center experience preferred and/or is currently demonstrating customer service skills, meeting current department metric and attendance guidelines within department. Some knowledge of CRM and Facets, as well as any other databases that may be used PHS Enterprise wide. *Researches inquiries/special projects as requested and responds to customer, partner or other PHS/PHP business units to ensure accuracy of benefit interpretation with results of research and resolution and within required timelines. $27k-32k yearly est.5d agoCall Center Representative-Patient Services-Work At Home
Qualifications High school diploma plus one to three years office/business experience; call center experience preferred and/or is currently demonstrating customer service skills, meeting current department metric and attendance guidelines within department. $27k-32k yearly est.6d agoRemote CCS Inpatient Facility Coder
Presbyterian's story is really the story of the remarkable people who choose to work here. Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more! From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. Now hiring a Remote CCS Inpatient Facility Coder! The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans. $22.4-34 hourly6d agoRemote CCS Inpatient Facility Coder
Presbyterian's story is really the story of the remarkable people who choose to work here. Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more! From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. Now hiring a Remote CCS Inpatient Facility Coder! The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans. $22.4-34 hourly6d agoIT SR Project Manager - Remote Eligible
Education/Experience Bachelor's Degree in Information Systems, Business Administration, Engineering, Nursing, Health Information Technology or related field of study is required. $41.8-63.9 hourly7d agoExpert Network Engineer - Remote Eligible
Presbyterian's story is really the story of the remarkable people who choose to work here. Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more! Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans. $41.8-63.9 hourly8d agoExpert Network Engineer - Remote Eligible
Presbyterian's story is really the story of the remarkable people who choose to work here. Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more! Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans. $41.8-63.9 hourly8d agoSenior Epic Configuration Analyst - Willow/ Beacon Certification - Remote Eligible
The Senior Epic Configuration Analyst routinely performs in-depth analysis of workflows, data collection, and other technical issues associated with the use of Epic software; is responsible for design, build, testing, and maintain those solutions * The Senior Epic Configuration Analyst is responsible for in-depth knowledge of assigned Epic System software. $36.2-55.3 hourly8d agoAssociate Business Analytic Consultant - Remote Eligible
$38.9-59.4 hourly11d ago
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