Molina Healthcare

The role is responsible for serving as the Subject Matter Expert for Medicaid risk adjustment programs across multiple states, which includes maintaining the risk adjustment model, estimating risk scores, and analyzing their impact. Additional opportunities involve leading national risk adjustment studies.

The Care Manager provides support for care management and care coordination for long-term services and supports, collaborating with a multidisciplinary team to ensure integrated delivery of member care across the continuum. Essential duties include completing comprehensive member assessments, facilitating waiver processes, developing and implementing care plans, and monitoring their effectiveness to achieve desired outcomes.

This role provides entry-level analyst support for provider configuration, focusing on the accurate and timely maintenance of critical provider information across claims and provider databases. Responsibilities include receiving and analyzing provider data for loading/updates, maintaining demographic data standards, and auditing loaded records for quality and financial accuracy.

Provides administrative level support to an Executive and division team members. Prioritizes management/client requests in order to meet business objectives. Supports the day-to-day administrative operations of the Executive and department. Composes routine executive corresponden...

The Care Manager provides support for care management and care coordination for long-term services and supports, collaborating with a multidisciplinary team to deliver integrated care across the continuum for high-need members. Essential duties include completing comprehensive member assessments, developing and implementing care plans, and monitoring their effectiveness to ensure progress toward desired outcomes.

This role supports medical records collection activities, primarily through outreach to providers via phone, fax, mail, EMR retrieval, and on-site pickup for HEDIS-specific data collection and quality improvement projects. Responsibilities also include loading collected records into the HEDIS application and providing project management support for data pursuit and collection.

This role involves providing analyst support for claims research, which includes reviewing claims for regulatory compliance, identifying processing errors, and coordinating remediation plans through resolution. The analyst will also serve as a claims subject matter expert, interpreting findings and leading complex claims projects.

Leads and directs team responsible for health plan provider network contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Collaborates with senior leadership and the corporate network managem...

Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role include...

Provides senior level clinical support to quality team - contributing to quality management programs, initiatives, audits, data analysis and quality improvement surveys and state/federal quality compliance activities. Contributes to overarching strategy to provide safe, efficient...