Molina Healthcare jobs
Senior Medical Director (IPA- Based in CA)
JOB DESCRIPTION Job SummaryLeads and manages a team of medical directors delivering oversight and expertise in appropriateness and medical necessity of services provided to members - ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care.
Position is based in California.
Essential Job Duties
Leads a team of medical directors responsible for assessing appr...
Delegation Oversight Nurse
JOB DESCRIPTION
This position is responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and State Medicaid requirements including delegation standards and requirements contained in the delegation agreement.
Essential Job Duties
TheDelegation Oversight Nurseis responsible for ensuring that Molina Healthcare's UM delegates are compliant al...
Delegation Oversight Nurse
JOB DESCRIPTION
This position is responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and State Medicaid requirements including delegation standards and requirements contained in the delegation agreement.
Essential Job Duties
TheDelegation Oversight Nurseis responsible for ensuring that Molina Healthcare's UM delegates are compliant al...
Specialist, Member & Community Interventions (Remote in CA)
Job Description
Job Summary
The Specialist, Member & Community Interventions implements new and existing clinical quality member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid) Executes health plans member and community quality focused interventions and programs in accordance with prescribed program standards, conducts data collection, monitors intervention activity including key perfor...
Director, Medical Logistics & Capacity (Clinical Initiatives / Nurse Practitioner Scheduling) – REMOTE
Job Description
Job Summary
The Director of Logistics and Capacity leads and directs the logistics of Nurse Practitioner (NP) scheduling and capacity by utilizing process improvement methodologies in the analysis of current operations and design of improvement projects across all areas that impact operations. Works with various functional leaders and other members of the executive team to drive the execution of clinical initiatives acro...
Auditor, Healthcare Services (RN)
JOB DESCRIPTION Job Summary
Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.
Performs audits in utilization management, care management, member assessment, behavioral health, and/or ...
Analyst, Data (Must live in California)
JOB DESCRIPTION
Job 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 customer...
Analyst, Data
Senior Provider Relations Representative
***Remote and must live in Southern California for provider visits***
JOB DESCRIPTION
Job Summary
Provides senior level support for health plan provider relations activities. Supports provider issue resolution, provider training, and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, ...