Presbyterian jobs in Rio Rancho, NM

We at Bestica believe our success is a direct result of hard work and outstanding employee dedication. Our environment is dynamic, friendly, and collaborative. We foster a positive culture, where innovation and synergy are encouraged to build our workplace into a community of like-minded, passionate people. Bestica is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. If this opportunity aligns with your capabilities and career desires, please take a moment to visit our website at ****************

Join Our Phoenix, Arizona, Team as an Anesthesiologist- A Role Designed for You We believe in bringing “better” to our local community in Phoenix-better care, better collaboration, and a deep commitment to the people we serve. We'd love to talk if you're looking for a role that supports your professional growth and connection to a vibrant community. People First in Phoenix Local Team Collaboration: Join our close-knit team of 16 physicians and 39 CRNAs at Banner University Medical Center. Work alongside other highly motivated anesthesiologists in a strong care team model style practice. We foster close collaboration with our surgical and perioperative colleagues, ensuring we collectively provide the highest standard of anesthesia care for the Phoenix community. Qualifications: Board-certified/eligible in anesthesia. Great opportunity for experienced Anesthesiologists or individuals just starting their careers. New graduates, residents, and fellows are welcome to apply. Practice in the Heart of the Community Flexible Scheduling: 44 weeks a year, average of 4 5hours a week, 8 Weeks PTO Our team boasts high retention rates, with collaborative efforts to ensure coverage during time off. No overnights or weekends are required. Key Responsibilities: Physicians act in both a supervisory role and also shifts performing clinical work independently. Banner University Medical Center is a nationally recognized, 733-bed academic Level I Trauma Center and one of Arizona's leading hospitals. Living and Working in Phoenix: Phoenix is where the sun never stops shining, and the stunning desert landscape matches the city's energy. As Arizona's capital, Phoenix offers a bustling urban vibe alongside easy access to the state's natural beauty. Whether you enjoy the vibrant arts scene, explore hiking trails, or experience a diverse food culture, Phoenix offers something for everyone in this southwestern oasis. Purpose-Driven Work with Local Impact Phoenix-Centered Care: Our guiding principle is patient-first care, which means we're focused on the people of Phoenix and nearby areas. You'll be part of a team that's making a real difference in the health of our neighbors. We take pride in our community-minded approach, actively encouraging team members to contribute to community health and wellness within and outside the hospital. We have a talented group of mostly fellowship-trained physicians and some of the strongest CRNAs in the Valley. Rewards and Benefits: Compensation: 44 weeks a year- W2: $450K to $600K (with call) 1099: $467K to $700K (with call) Sign-on bonus and quality bonus available Benefits: Comprehensive benefits package, including medical, dental, vision, and life insurance. 401k with matching contributions. Paid malpractice insurance with tail coverage. 8 weeks of scheduled time off annually. Annual CME allowance. By applying, you consent to your information being transmitted by JobFlow to the Employer, as data controller, through the Employer's data processor SonicJobs. See Sound Physicians Terms & Conditions at and Privacy Policy at and SonicJobs Privacy Policy at and Terms of Use at

About Sound: Headquartered in Tacoma, WA, Sound Physicians is a physician-founded and led, national, multi-specialty medical group made up of more than 1,000 business colleagues and 4,000 physicians, APPs, CRNAs, and nurses practicing in 400-plus hospitals across 45 states. Founded in 2001, and with specialties in emergency and hospital medicine, critical care, anesthesia, and telemedicine, Sound has a reputation for innovating and leading through an ever-changing healthcare landscape - with patients at the center of the universe. Sound Physicians offers a competitive benefits package inclusive of the items below, and more: * Medical insurance, Dental insurance, and Vision insurance * Health care and dependent care flexible spending account * 401(k) retirement savings plan with a company match * Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policy * Ten company-paid holidays per year About the Team: The Practice Coordinator works with the Sound Physician's team onsite at the hospital partner daily. This team consists of a Practice Medical Director, Clinicians, and a Clinical Performance Nurse. About the Role: The Practice Coordinator is responsible for daily oversight of administrative responsibility for the Sound site practice. The Practice Coordinator will have a visible presence and involvement with the entire practice team and multiple hospital departments including the Medical Staff Office, community providers and specialty physicians. This position is responsible for contributing to improved workflow processes, communications, and standards, as well as onsite initiatives for operational, financial, and clinical performance. The Details: This is a (Part/Full-Time) role working on-site at our practice, at the hospital. There are no travel requirements for this role. In this role, you will be responsible for: Practice Operations and Support * General administrative support to medical practice, under the direction of the medical director and practice administrator, if applicable * Providing office management functions to include, but not limited to, all aspects of meeting management, office systems, supplies, practice events * Collaborating with Medical Director and Practice Management Team in developing and maintaining site practice policies and procedures * As applicable to the practice line, facilitating all aspects of the daily patient census/reconciliation and daily multi-disciplinary rounds * Administratively enabling patient care through facilitating home health order workflows, responding to medical records requests, coordinating patient PCP follow up appointments and completion of death certificates * Ensuring all aspects of recruiting are executed, including coordination of onsite interviews with hospital leadership, promoting a positive candidate experience (interviewing and site visits) * Ensuring all aspects of on-boarding and orientation are completed for new clinicians as well as locums & ambassadors * Developing and maintain practice orientation checklists and policies * Ensuring all licensed providers complete their recredentialing in a timely manner and appropriately for their licensing, certificates, and credentials required by Sound and hospital Medical Staff Office. Ensuring compliance with reappointments and monitors state licenses expirables * Ensuring clinicians obtain hospital privileging and payer enrollment is complete prior to patient care * Managing relationship with hospital Medical Staff Office, troubleshooting barriers to on-time starts * Ensuring billing and documentation compliance for the practice * Ensuring clinicians participate in mandatory compliance training and remediation, if required, and that clinicians timely query responses and participation in compliance activities * Participating in all medical group training offered by Sound pertinent to role and responsibilities * Supporting clinicians in open enrollment for benefits on annual basis, demonstrating an understanding of Sound's benefits plan. Supporting clinicians through entry of life event changes in Sound's HR Information System * Providing general support for all Sound software applications * Establishing and maintaining group norms for the practice team, at direction of medical director * Maintaining visual/management boards to support team communications and recognition * Training/mentoring practice coordinators, as requested * Encouraging practice participation in Sound bedside/colleague engagement surveys Staffing Operations * Creating and optimizing clinical schedule, ensuring accurately documented shifts for payroll processing. Promoting practice sustainability with no disruption to patient care 120 days in advance * Reviewing and validating shift and productivity data for appropriate processing by payroll each month Client Retention * Serving as general administrative liaison to hospital executives and staff regarding hospital needs * Coordinating monthly and quarterly meetings and events, both within practice team and with hospital partner leadership, including scheduling, agenda, room/material facilitation, and meeting minutes * Ensuring client facing materials are refreshed with Sound current standards * Maintaining reports/trackers as requested * Ensuring accuracy of PCP database and distribution of PCP list What we are looking for: A successful candidate will have a demonstrated track record of a combination of these values, knowledge, and experience: Values: * Collaboration: Demonstrates the ability to work well with others to accomplish a goal and get the work done; takes opinions of others into consideration; includes others in the decision-making process * Customer-focus: Puts customer (internal and external) needs first and makes customers their top priority * Eagerness to Learn: Proactively seeks out information, embraces learning new things and enjoys the learning process * Likes people: Genuinely enjoys engaging with and helping others; feels a sense of accomplishment through helping and working with other people * Self-starter: Demonstrates the ability to jump in and start a task or project with limited direction * Resourcefulness: Proactive willingness to utilize available information and tools to figure things out Knowledge: * Intermediate Microsoft Office proficiency (i.e. Outlook, Excel and PowerPoint) * Knowledge of relevant state and federal healthcare regulations * Knowledge of HR information systems and basic HR knowledge Experience: * 1-2 years of administrative support experience, preferably in a hospital or healthcare environment * 1-2 years in customer service Pay Range: $19-$30.00 hourly. Exact pay will be determined based on candidate experience, geographical location, and size/complexity of the program being supported. Sound Physicians is an Equal Employment Opportunity (EEO) employer and is committed to diversity, equity, and inclusion at the bedside and in our workforce. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, gender identity, sexual orientation, age, marital status, veteran status, disability status, or any other characteristic protected by federal, state, or local laws. This reflects the present requirements of the position. As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment.

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. •Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. * Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse incidents and quality of care concerns. * Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. * Reviews quality referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. * Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. * Ensures medical protocols and rules of conduct for plan medical personnel are followed. * Develops and implements plan medical policies. * Provides implementation support for quality improvement activities. * Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. * Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. * Actively participates in regulatory, professional and community activities. Required Qualifications * At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. * Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state (New Mexico) of practice. * Board certification. * Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. * Ability to work cross-collaboratively within a highly matrixed organization. * Strong organizational and time-management skills. * Ability to multi-task and meet deadlines. * Attention to detail. * Critical-thinking and active listening skills. * Decision-making and problem-solving skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. 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 #PJHS #LI-AC1 Pay Range: $186,201.39 - $363,093 / 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.

JOB DESCRIPTIONJob Summary Designs and implements processes and solutions associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and unstructured data from multiple disparate sources. Collaborates across departments and with customers to define requirements and understand business problems. Uses advanced mathematical, statistical, querying, and reporting methods to develop solutions. Develops information tools, algorithms, dashboards, and queries to monitor and improve business performance. Creates solutions from initial concept to fully tested production, and communicates results to a broad range of audiences. Effectively uses current and emerging technologies. KNOWLEDGE/SKILLS/ABILITIES * Extracts and compiles various sources of information and large data sets from various systems to identify and analyze outliers. * Sets up process for monitoring, tracking, and trending department data. * Prepares any state mandated reports and analysis. * Works with internal, external and enterprise clients as needed to research, develop, and document new standard reports or processes. * Implements and uses the analytics software and systems to support the departments goals. JOB QUALIFICATIONS Required Education Associate's Degree or equivalent combination of education and experience Required Experience 1-3 years Preferred Education Bachelor's Degree or equivalent combination of education and experience Preferred Experience 3-5 years To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $116,835 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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 (RN) Registered Nurse who must hold a compact license. , home office with internet connectivity of high speed required Work Schedule Monday to Friday - operation hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes clinical service requests from members or providers against evidence based clinical guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. • Processes requests within required timelines. • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote the Molina care model. • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified Professional in Healthcare Management (CPHM). • Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $61.79 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or readjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $38.37 / 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.

Leads and supervises a team of pharmacy call center representatives and operations staff responsible to ensure that members have access to medically necessary prescription drugs. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. **Essential Job Duties** - Hires, trains, develops, and supervises a team of pharmacy service representatives supporting processes involved with Medicare Stars and Pharmacy quality operations. - Ensures that average phone call handle time, average speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. - Ensures that adequate staffing coverage is present at all times of operation. - Assists pharmacy leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions. - Responsible for key performance indicators (KPI) reporting to department leadership on a monthly basis. - Participates, researches, and validates materials for both internal and external program audits. - Acts as liaison to internal and external customers to ensure prompt resolution of identified issues. - Assists pharmacy leadership in the collection and tabulation of data for reporting purposes and maintains files of confidential information submitted for review. - Assures that activities and processes are compliant with CMS, National Committee of Quality Assurance (NCQA) guidelines, and Molina policies and procedures. - Participates in the daily workload of the department, performing Representative duties as needed. - Facilitates interviews with pharmacy service representative job applicants, and provides hiring recommendations to leadership. - Provides coaching for pharmacy representatives, and helps identify and provide for training needs in collaboration with pharmacy leadership. - Communicates effectively with practitioners and pharmacists. - Collaborates with and keeps pharmacy leadership apprised of operational issues, including staffing resources, program and system needs. - Assists with development of and maintenance of pharmacy policies and procedures - Participates in the development of programs designed to enhance preferential or required targeted drugs or supplies. **Required Qualifications** - At least 5 years of experience in health care, preferably within a health-related call center environment, or equivalent combination of relevant education and experience. - Knowledge of prescription drug products, dosage forms and usage. - Experience designing, implementing, monitoring, and evaluating metrics that measure call center agent productivity. - Working knowledge of medical/pharmacy terminology - Excellent verbal and written communication skills. - Microsoft Office suite, and applicable software program(s) proficiency. **Preferred Qualifications** - Supervisory/leadership experience. - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Call center experience. - Managed care experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $55,706.51 - $80,464.96 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management. **Job Duties** + Active collaborator with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. + Plans and directs schedules as well as project budgets. + Monitors the project from inception through delivery. + May engage and oversee the work of external vendors. + Focuses on process improvement, organizational change management, program management and other processes relative to the business. + Leads and manages team in planning and executing business programs. + Serves as the subject matter expert in the functional area and leads programs to meet critical needs. + Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed. + Works with operational leaders within the business to provide recommendations on opportunities for process improvements. + Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations. + Generate and distribute standard reports on schedule **JOB QUALIFICATIONS** **REQUIRED EDUCATION** : Bachelor's Degree or equivalent combination of education and experience. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : + 3-5 years of Program and/or Project management experience. + Operational Process Improvement experience. + Healthcare experience. + Experience with Microsoft Project and Visio. + Excellent presentation and communication skills. + Experience partnering with different levels of leadership across the organization. **PREFERRED EDUCATION** : Graduate Degree or equivalent combination of education and experience. **PREFERRED EXPERIENCE** : - 5-7 years of Program and/or Project management experience. - Managed Care experience. - Experience working in a cross functional highly matrixed organization. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : - PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification and/or comparable coursework desired. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Facility in central New Mexico is in need of help in their Operating Room. OR Tech travelers are needs for ASAP start and 13 week assignments. Candidates should have 2 years experience, and be certified CST and BLS. Prior travel experience is needed for submittal. Call Ventura Medstaff today for more information at ************.

Provides lead level analyst support for configuration information management activities. Responsible for accurate and timely implementation and maintenance of critical information on claims databases, synchronizing operational and claims systems data and application of business rules as they apply to each database, validating data to be housed on databases, and ensuing adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. Essential Job Duties * Analyzes and interprets data to determine appropriate configuration changes. * Accurately interprets specific state and/or federal benefits, in addition to other business requirements, and converts terms to configuration parameters. * Manages coding, updating and maintaining benefit plans, provider contracts, fee schedules and various system tables in the user interface. * Applies experience and knowledge to research and resolve claim/encounter issues and pended claims, and updates system(s) as necessary. * Loads and maintains contracts, benefit and/or reference table information into the claims payment system and other applicable systems. * Participates in defect resolution for assigned component(s). * Participates in the implementation and conversion of new and existing health plans. * Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. * Assists with development of configuration standards and best practices, and suggests improvement processes to ensure systems are working efficiently and enhance quality. * Creates reporting tools to enhance communication on configuration updates and initiatives. * Negotiates expected configuration information management completion dates with health plans. * Collaborates with internal and external stakeholders to understand business objectives and processes. * Solutions with health plans and corporate functions to ensure all end-to-end business requirements have been documented. * Assists leadership in establishing standards, guidelines, and best practices for the configuration information management team. * Represents as a departmental configuration information management subject matter expert. * Supports various department-wide configuration information management projects. * Provides training and support to new and existing configuration information management team members, including configuration functionality, enhancements and updates * Manages fluctuating volumes of work, and prioritizes work to meet deadlines and needs of the configuration department and user community. Required Qualifications * At least 5 years of configuration information management experience maintaining databases, and/or analyst experience within a health care operations setting in a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs, or equivalent combination of relevant education and experience. * Must have Contract configuration experience in Networx. * Experience with QNXT is preferred. * Advanced experience using a claims processing system. * Advanced experienced verifying documentation related to updates/changes within a claims processing system. * Advanced experience validating and confirming information related to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, and other business requirements. * Analytical and critical-thinking skills. * Flexibility to meet changing business requirements, and commitment to high-quality/on-time delivery * High attention to detail. * Effective verbal and written communication skills. * Microsoft Office suite proficiency, including intermediate to advanced Excel abilities (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency. 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 - $155,508 / 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.

This position will be responsible for supporting the execution of merger and acquisition transactions and will actively contribute in advancing Molina Healthcare's overall growth strategy. The role entails working closely with the senior members of the Corporate Development team and will actively interact with the business leaders and senior management team at Molina. The ideal candidate will have at least two years of experience as an analyst at an investment bank or similar firm. **Knowledge/Skills/Abilities** - Develop financial models and perform analyses to assess potential acquisition, joint venture and other business development opportunities (i.e., discounted cash flow, internal rate of return and accretion/dilution) - Prepare ad-hoc analyses and presentations to help facilitate various discussions - Research and analyze industry trends, competitive landscape and potential target companies - Coordinate deal activities among internal cross-functional teams and external parties - Coordinate due diligence and closing-related activities - Actively participate in reviewing and negotiating transaction agreements - Prepare board and senior management presentations **Job Qualifications** **REQUIRED EDUCATION:** Bachelor's degree in Accounting or Finance or related fields **REQUIRED EXPERIENCE:** + Minimum 5 years' experience in financial modeling and analysis + Ability to synthesize complex ideas and translate into actionable information + Strong analytical and modeling skills + Excellent verbal and written communication skills + Highly collaborative and team-oriented with a positive, can-do attitude + Ability to multi-task, set priorities and adhere to deadlines in a high-paced organization **PREFERRED EXPERIENCE:** + Prior analyst experience in investment banking strongly preferred + Healthcare industry experience preferred **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. \#PJCorp \#LI-AC1 Pay Range: $80,412 - $156,803 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. Job Duties Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions. Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. Identifies and reports quality of care issues. Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience. Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings. Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. Supplies criteria supporting all recommendations for denial or modification of payment decisions. Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. Provides training and support to clinical peers. Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols. Job Qualifications REQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice. Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). Experience working within applicable state, federal, and third-party regulations. Analytic, problem-solving, and decision-making skills. Organizational and time-management skills. Attention to detail. Critical-thinking and active listening skills. Common look proficiency. Effective verbal and written communication skills. Microsoft Office suite and applicable software program(s) proficiency. PREFERRED QUALIFICATIONS: Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications. Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics. Billing and coding 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: $29.05 - $67.97 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Performs and assists the electrophysiologists with the most complex electrophysiology studies. Performs at an expert clinical level and assists the physician in the performance of pediatric and adult electrophysiology procedures; including both diagnostic and interventional.

Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. - Facilitates comprehensive waiver enrollment and disenrollment processes. - Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. - Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. - Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. - Assesses for medical necessity and authorizes all appropriate waiver services. - Evaluates covered benefits and advises appropriately regarding funding sources. - Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. - Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. - Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. - Identifies critical incidents and develops prevention plans to assure member health and welfare. - Collaborates with licensed care managers/leadership as needed or required. - 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications - At least 2 years health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. -Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. - In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). - Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. - Demonstrated knowledge of community resources. - Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. - Ability to operate proactively and demonstrate detail-oriented work. - Ability to work independently, with minimal supervision and self-motivation. - Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations. - Ability to develop and maintain professional relationships. - Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. - Excellent problem-solving, and critical-thinking skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. - In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). Preferred Qualifications - Certified Case Manager (CCM), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice. - Experience working with populations that receive waiver services. 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: $24 - $56.17 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

A Surgical Technician assists in surgeries by preparing operating rooms, sterilizing instruments, and supporting the surgical team. Responsibilities include ensuring patient safety, maintaining sterile environments, and handling surgical tools during procedures. Apply for specific facility details.

Join the Top- Rated Travel Healthcare Team! Skyline Med Staff was named as the #1 Best Travel Healthcare Company in 2025 by BluePipes, a recognition driven by glowing reviews from travel healthcare professionals. Our recruiters are consistently praised on Google for their responsiveness, dedication, accessibility, and industry knowledge. Ready to experience the difference? Apply for a job today and see why healthcare professionals choose Skyline! As a traveler with Skyline Med Staff, you'll have a dedicated recruiter supporting you every step of the way and available whenever you need them. We are a Woman Owned Agency providing clinicians with Health Insurance through Blue Cross Blue Shield, along with Dental and Vision coverage, plus $500 referral bonuses! We're seeking committed healthcare professionals who excel in delivering quality patient care and can adapt to diverse work environments. Required for Submission: 1. Minimum of 1 year recent work experience in the specialty of the job applying for 2. A current BLS/CPR certification through American Heart Association 3. Active License in the state of the job location (if applicable) We look forward to connecting and working with you to find your next job opportunity!

Leads and supervises a team of pharmacy call center representatives and operations staff responsible to ensure that members have access to medically necessary prescription drugs. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job Duties * Hires, trains, develops, and supervises a team of pharmacy service representatives supporting processes involved with Medicare Stars and Pharmacy quality operations. * Ensures that average phone call handle time, average speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. * Ensures that adequate staffing coverage is present at all times of operation. * Assists pharmacy leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions. * Responsible for key performance indicators (KPI) reporting to department leadership on a monthly basis. * Participates, researches, and validates materials for both internal and external program audits. * Acts as liaison to internal and external customers to ensure prompt resolution of identified issues. * Assists pharmacy leadership in the collection and tabulation of data for reporting purposes and maintains files of confidential information submitted for review. * Assures that activities and processes are compliant with CMS, National Committee of Quality Assurance (NCQA) guidelines, and Molina policies and procedures. * Participates in the daily workload of the department, performing Representative duties as needed. * Facilitates interviews with pharmacy service representative job applicants, and provides hiring recommendations to leadership. * Provides coaching for pharmacy representatives, and helps identify and provide for training needs in collaboration with pharmacy leadership. * Communicates effectively with practitioners and pharmacists. * Collaborates with and keeps pharmacy leadership apprised of operational issues, including staffing resources, program and system needs. * Assists with development of and maintenance of pharmacy policies and procedures * Participates in the development of programs designed to enhance preferential or required targeted drugs or supplies. Required Qualifications * At least 5 years of experience in health care, preferably within a health-related call center environment, or equivalent combination of relevant education and experience. * Knowledge of prescription drug products, dosage forms and usage. * Experience designing, implementing, monitoring, and evaluating metrics that measure call center agent productivity. * Working knowledge of medical/pharmacy terminology * Excellent verbal and written communication skills. * Microsoft Office suite, and applicable software program(s) proficiency. Preferred Qualifications * Supervisory/leadership experience. * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Call center experience. * Managed care experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $55,706.51 - $80,464.96 / 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.

Join our team as a Hospitalist or Nocturnist Physician in Rio Rancho, New Mexico, just 30 minutes outside of Albuquerque. In Rio Rancho, we are committed to bringing "better" to life-through better care, better collaboration, and a steadfast commitment to our community. If you're looking for a role where you can thrive professionally while contributing to a vibrant community, we'd love to hear from you. We are hiring for both Hospitalist and Nocturnist positions. Our Nocturnist role requires working exclusively overnight shifts. Candidates must be comfortable with a nocturnist schedule and possess the ability to deliver exceptional patient care during nighttime hours. People First in Rio Rancho Local Team Collaboration: * Join our team of eight physicians at the UNM Sandoval Regional Medical Center. * Work alongside a unique group of clinicians with diverse geographic, educational, and training backgrounds. * We work closely with our colleagues in other departments to ensure a seamless transition of care. Qualifications: * Candidates must be board-certified/eligible in internal medicine or family medicine. * The ability to handle complex medical and social scenarios is essential. * A patient-centered, compassionate mindset is a must. * Candidates must be authorized to work in the United States. Practice in the Heart of the Community Scheduling: * Full-time positions follow a 7 on / 7 off rotation * Day shift: 7:00 AM to 7:00 PM * Night shift: 7:00 PM to 7:00 AM Living and Working in Rio Rancho: * Family-friendly city with affordable housing, beautiful Sandia Mountain views, and 300+ days of sunshine. * 20 minutes to Albuquerque for cultural attractions, dining, shopping, and the International Balloon Fiesta. * 1 hour to Santa Fe for world-class art, historic architecture, festivals, and outdoor adventures. Purpose-Driven Work with Local Impact Rio Rancho-Centered Care: * Patient care is our top priority, always. * We value and support growth and development in our hospital medicine practice, allowing you to explore new opportunities locally and within the broader medical group. Rewards and Benefits: * Compensation: * Compensation for days is $1,829 per shift. * Compensation for nights is $2,109 per shift. * We also offer quality and productivity incentives. * Benefits: * Comprehensive benefits package, including medical, dental, vision, and life insurance. * 401 (k) with matching contributions. * Paid malpractice insurance with tail coverage. * Annual CME allowance. Tagged as: Physician