Molina Healthcare jobs
Abstractor, HEDIS /Quality Improvement (Remote)
Job Summary
Molina's Quality Improvement Abstraction team functions to conduct data collection and abstraction of medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The abstraction team will meet chart abstraction productivity standards as well as minimum over read standards.
Job Duties
- Coordinates the HEDIS medical record review which includes on...
Care Manager (RN) (Must reside in CA) (Spanish Speaking)
JOB DESCRIPTION
Job Summary
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. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effect...
Director, Provider Relations (California)
Job Description
Job Summary
Responsible for leading provider network operations, contracting support, policies and procedures, and provider communications. Oversees Managers and Specialists to ensure compliance with federal, state, and local regulatory requirements while aligning with Molina Healthcares mission and strategic goals. Partners with network contracting, operations, government contracts, compliance, and systems teams to dri...
Provider Relations Representative
***Remote and must live in California***
Job Description
Job Summary
Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations ...
Analyst, Risk & Quality Reporting (Remote)
JOB DESCRIPTION
Job Summary
The Analyst, Risk and Quality Reporting role supports Molinas Risk and Quality Health Plan team. This position designs and develops custom health plan reports to support local interventions, provider outreach, and tracks outcomes of the initiatives. Educates users on how to use reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP.
Job Duties
Care Management Processor (Must reside in CA)
JOB DESCRIPTION
Job Summary
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. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effect...
Care Review Clinician (RN) California
***California residents preferred.
EMERGENCY ROOM ADMISSIONS REVIEW NURSE
3-12 DAY SHIFT7:30AM - 08:30PM PACIFIC HOURS NON EXEMPT, 3 days a week will rotate.
OR
3-12 NIGHT SHIFT 7:30PM - 08:30AM PACIFIC HOURS NON EXEMPT, 3 days a week will rotate.
TRAINING SCHEDULE WILL BE Monday thru Friday8:30AM to 5:30PM PACIFIC throughout a 2 - 3 month training and then will move to a 3 day...
Provider Contracts Specialist
***Remote and must live in California***
Job Description
Job Summary
Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state a...