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 ap...
Care Review Clinician- HLOC- Utilization Review (RN- CA license)
JOB DESCRIPTION
Job Summary
Provides 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. This role arranges tra...
Care Review Clinician- Inpatient Utilization Review (RN-CA License)
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
As...
(RN)Healthcare Services Supervisor- Inpatient UM/UR (CA License Required)- REMOTE
JOB DESCRIPTION
Job Summary
Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to pr...
Associate Analyst, Data
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 customers to define req...
Care Manager (RN)
JOB DESCRIPTION Job Summary
Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. 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 assessments of members per regulated timelines and determines wh...
AVP, Provider Network Management & Operations (California)
JOB DESCRIPTION Job Summary
Provides strategy and leadership to team responsible for network operations and contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Also responsible for negotiating complex contracts that are strategically critical to plan/product success, including but not limited to: alternative payment models (APMs), value-based payment (VBP) contracts and capitated payments...
Senior Architect, Information Security – Azure/Cloud- Remote
Job Summary
The Senior Security Architect will be a key leader in designing, evaluating, and enforcing security controls across our enterprise cloud and network environments. This role will focus on security reviews, network change assessments, cloud security architecture, and policy development, ensuring alignment with industry best practices and regulatory requirements. The ideal candidate will have a passion for technology and security, along with a deep expertise in Azure clou...
Representative, Care Connections Member Advocate – Must Be Bilingual in Spanish – CA ONLY
Job Description
Please note the required shifts are Mon - Fri 10:00 AM 7:00 PM or Tues - Sat 7:00AM - 4:00PM Pacific Time Zone.
Job Summary
Makes outbound calls to members, completes assigned hand-dial lists, and provides proactive member support, information, and assistance. Adheres to member interaction departmental standards, call quality, and documentation requirements.
Job Duties