Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care. 

Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.

Industry: Hospitals and Health Care
Company Size: 10,001+ employees

Molina Healthcare

Savvy Admin PROD

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 provide quality and cost-effective member care.

Essential Job Duties

• Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.

• Functions as a "hands-on" supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.

• Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.

• Trains and supports team members to ensure high-risk, complex members are adequately supported.

• Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.

• Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.

• Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.

• Local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 5 years health care experience, and at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. r equivalent combination of relevant education and experience.

• Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.

• Ability to manage conflict and lead through change.

• Operational and process improvement experience.

• Strong written and verbal communication skills.

• Working knowledge of Microsoft Office suite.

• Ability to prioritize and manage multiple deadlines.

• Excellent organizational, problem-solving and critical-thinking skills.

Preferred Qualifications

• Registered Nurse (RN). License must be active and unrestricted in state of practice.

• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.

• Medicaid/Medicare population experience.

• Clinical experience.

• Supervisory/leadership experience.

#PJHPO3

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: $66,456 - $129,590 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Supv, Healthcare Services

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 provide quality and cost-effective member care.

Essential Job Duties

• Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.

• Functions as a "hands-on" supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.

• Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.

• Trains and supports team members to ensure high-risk, complex members are adequately supported.

• Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.

• Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.

• Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.

• Local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 5 years health care experience, and at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. r equivalent combination of relevant education and experience.

• Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.

• Ability to manage conflict and lead through change.

• Operational and process improvement experience.

• Strong written and verbal communication skills.

• Working knowledge of Microsoft Office suite.

• Ability to prioritize and manage multiple deadlines.

• Excellent organizational, problem-solving and critical-thinking skills.

Preferred Qualifications

• Registered Nurse (RN). License must be active and unrestricted in state of practice.

• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.

• Medicaid/Medicare population experience.

• Clinical experience.

• Supervisory/leadership experience.

#PJHPO2

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: $66,456 - $129,590 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION

Must reside in Florida

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.

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 cases 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 health care experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.

• Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, 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 a medical unit or emergency room.

#PJHS2

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 - $46.81 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Care Review Clinician - Remote in FL

**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 provide quality and cost-effective member care.

**Essential Job Duties**

-  Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.

-  Functions as a "hands-on" supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.

-  Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.

-  Trains and supports team members to ensure high-risk, complex members are adequately supported.

-  Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.

-  Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.

-  Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.

-  Local travel may be required (based upon state/contractual requirements).

**Required Qualifications**

-  At least 5 years health care experience, and at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. r equivalent combination of relevant education and experience.

-  Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.

-  Ability to manage conflict and lead through change.

-  Operational and process improvement experience.

-  Strong written and verbal communication skills.

-  Working knowledge of Microsoft Office suite.

-  Ability to prioritize and manage multiple deadlines.

-  Excellent organizational, problem-solving and critical-thinking skills.

**Preferred Qualifications**

-  Registered Nurse (RN). License must be active and unrestricted in state of practice.

-  Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.

-  Medicaid/Medicare population experience.

-  Clinical experience.

-  Supervisory/leadership experience.

#PJHPO3

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: $66,456 - $129,590 / ANNUAL

- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**Job Summary **

Provides support and subject matter expertise for clinical pediatric pharmacy services and support. Contributes to overarching clinical pediatric pharmacy strategy for optimization of clinical and medication-related health care outcomes, and quality cost-effective member care.

**Essential Job Duties**

• Provides clinical pediatric rounds support including examination of member medical records, comprehensive medication reviews, and communication with Health Care Services leadership and nurse case managers who provide outbound support to members and providers

• Support clinical case referrals from Health Care Services/nurse case managers through reviews of member medication profiles and applyingevidence-based medicine and national guidelines when creating recommendations for health care providers for optimization of member medication regimens.

• Analyzes and reviews medication lists for potential patient safety issues, including drug interactions, suboptimal medication regimens, etc in both clinical pediatric rounds and clinical case referral support.

• Promotes clinically appropriate prescribing practices based on evidence-based medicine and national guidelines through various modalities (provider/plan profiling, member drug profile reviews, medication protocols/criteria, and case-by-case interventions).

• Conducts training as needed to Health Care Services leadership/nurse case managers on self-serve pharmacy resources (formulary lookup, pharmacy locator, etc) as well as articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed.

• Researches, develops, and implements drug utilization and disease state management strategies and intervention techniques to deliver high quality, cost effective health care.

• Assists Health Care services leadership and nurse case managers in coordination of care for pharmacy-related issues as nurse case managers provide the necessary outbound health plan service support to members, their caregivers, and providers.

• Serves as a pediatric drug information resource to pharmacy staff, Health Plan Chief Medical Officer, and Health Plan Health Care Services/nurse case manager staff

• Reviews and analyzes clinical reports generated internally or through external Pharmacy Benefit Manager (PBM) to track general clinical trends in drug utilization and identify potential clinical trend issues to be addressed

• Works with Healthcare Services team (e.g., data managers, care managers, etc.) on member-centered interdisciplinary teams.

• Assists leadership in developing/updating policies and procedures, and implementing changes to comply with state and federal regulations.

**Required Qualifications**

• Doctor of Pharmacy (PharmD). Resident of Florida with active Florida License must be active and unrestricted in applicable state(s) of practice.

• Demonstrated knowledge and expertise in clinical pharmacology and disease management for pediatric populations.

• Clinical skills related to  pediatric pharmacy And demonstrated knowledge of best practices in clinical pediatric-related disease states.

• Current knowledge and expertise in clinical pharmacology and disease management.

• Ability to present ideas and information concisely to varied audiences.

• Knowledge of processes and systems, and ability to develop and deliver necessary training to departmental staff and internal customers.

• Ability to develops and maintain positive and effective work relationships with coworkers, members, providers, regulatory agencies and vendors.

• Proficiency in compiling data, creating reports and presenting information.

• Ability to meet established deadlines.

• Functions independently and manages multiple projects.

• Excellent verbal and written communication skills.

• Microsoft Office suite (including Excel), and applicable software program(s) proficiency.

**Preferred Qualifications **

• At least 3 years of experience in a Managed Care Pharmacy, Pharmacy Benefit Manager (PBM), or related healthcare organization (ie hospital, ambulatory care, etc) experience.

• Pediatric Pharmacy Specialty Certification (BCPPS®)

• Completion of a PGY1 residency plus two (2) additional years of post-licensure practice

• Completion of a specialty (PGY2) residency in pediatric pharmacy

• Medicaid experience

• Clinical skills or pharmacotherapy expertise for  clinical pediatric-related conditions and medications.

• Experience with team-based care.

#PJPharm

#HTF

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: $80,412 - $156,803.45 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Clinical Pediatric Pharmacist (CPP)

**Job Description**

**Must reside in Florida**

**Job Summary**

Provides lead level clinical support to healthcare services team supporting one or more of the following functions: care management, utilization management, care transitions, long-term services and supports (LTSS), behavioral health, and other clinical programs, 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**

-  Provides level support to healthcare services department staff - devising/implementing delegation assignment strategies, facilitating healthcare services processes and communicating/coordinating activities.

-  Resolves issues and complaints that arise in day-to-day healthcare services operations and communicates escalation issues to healthcare services leadership.

-  Assists in training of healthcare services staff according to department standards, policies and procedures.

-  Maintains a minimal caseload to ensure adherence to appropriate guidelines and provide assistance to staff who have an ongoing member caseloads that may required additional support.

-  Collaborates with and keeps healthcare service leadership apprised of operational issues, staffing issues, system and program needs.

-  As a subject matter expert clinical lead, provides support, recommendations and education as appropriate to all other clinical and non-clinical staff.

-  Monitors healthcare services staff workload for adherence to policies, procedures, guidelines, and program specific requirements.

-  Actively participates in the department auditing program to review, communicate findings and identify opportunities for improved quality and compliance.

-  Shares quality and productivity scores with individual staff for awareness.

-  Provides feedback to healthcare services leadership on staff performance issues and consults with leadership on corrective action as necessary for performance improvement.

-  May collaborate with leadership to ensure the daily authorization reconciliation report (DARR) is run each work day and cases found non-compliant or missing compliance elements are remediated promptly.

-  May collaborate with leadership ensuring the care management monitoring tool (CMMT) is run every work day and cases are addressed to maintain health rid assessment (HRA) and care plan compliance.

-  Acts as liaison to both internal and external customers on behalf of both Molina and healthcare services department areas.

-  Maintains confidentiality, effective workplace relationships and adheres to company code of conduct.

-  Attends/participates in departmental, company-wide, and external committees, task forces, or work groups as assigned. groups as assigned.

-  Local travel may be required (based upon state/contractual requirements).

**Required Qualifications**

-  At least 4 years experience in health care, and at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.

-  Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master Social Worker (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.

-  Demonstrated knowledge of community resources.

-  Proactive and detail-oriented.

-  Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.

-  Ability to work independently, with minimal supervision and demonstrate self-motivation.

-  Responsive in all forms of communication.

-  Ability to 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(s) proficiency.

**Preferred Qualifications**

-  Registered Nurse (RN). License must be active and unrestricted in state of practice.

-  Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.

-  Medicaid/Medicare population experience.

-  Clinical experience.

#PJHS

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 - $56.64 / HOURLY

- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Lead, Healthcare Services (Utilization Management) - Remote in FL

**Job Description**

**Job Summary**

Responsible 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 includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable.

**Job Duties**

- Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan developed requirements.

- Monitors sources to ensure all updates are aligned.

- Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations.

- Conducts analysis to identify root cause and assist with problem management as it relates to state requirements.

- Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices.

- Provides support for requirement interpretation inconsistencies and complaints.

- Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials.

- Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes.

**Knowledge/Skills/Abilities**

- Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation is agreed on and clear for solutioning.

- Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas.

- Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company.

- Ability to concisely synthesize large and complex requirements.

- Ability to organize and maintain regulatory data including real-time policy changes.

- Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems.

- Ability to work independently in a remote environment.

- Ability to work with those in other time zones than your own.

**Job Qualifications**

**Required Qualifications**

- At least 2 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience.

- Policy/government legislative review knowledge.

- Strong analytical and problem-solving skills.

- Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams.

- Previous success in a dynamic and autonomous work environment.

**Preferred Qualifications**

- Project implementation experience

- Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA).

- Medical Coding 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.

Pay Range: $44,936.59 - $97,362.61 / ANNUAL

- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Business Analyst - 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 provide quality and cost-effective member care.

**Essential Job Duties**

-  Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.

-  Functions as a "hands-on" supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.

-  Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.

-  Trains and supports team members to ensure high-risk, complex members are adequately supported.

-  Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.

-  Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.

-  Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.

-  Local travel may be required (based upon state/contractual requirements).

**Required Qualifications**

-  At least 5 years health care experience, and at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. r equivalent combination of relevant education and experience.

-  Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.

-  Ability to manage conflict and lead through change.

-  Operational and process improvement experience.

-  Strong written and verbal communication skills.

-  Working knowledge of Microsoft Office suite.

-  Ability to prioritize and manage multiple deadlines.

-  Excellent organizational, problem-solving and critical-thinking skills.

**Preferred Qualifications**

-  Registered Nurse (RN). License must be active and unrestricted in state of practice.

-  Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.

-  Medicaid/Medicare population experience.

-  Clinical experience.

-  Supervisory/leadership experience.

#PJHPO2

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: $66,456 - $129,590 / ANNUAL

- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

- Remote and must live in the United States***

**Job Description**

**Job Summary**

Responsible for multiple Enrollment 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 review enhancement ROI. Candidate must have strong analytic, organizational skills and the ability to independently resolve issues and remove hurdles. This is a hybrid role that requires Program Management, System Analyst and Sr. Business Analyst skills. Responsibilities include troubleshooting, analyzing, managing assignments, assisting team members, oversight of vendor projects, reviewing team outputs, reviewing deployment request and post deployment monitoring.

Building and maintaining strong relationships and proactive processes are key to the success of this team. The selected candidate would act as the liaison between the business, vendors, IT, and support Program Managers and Business Analyst in a subject matter expert capacity. May engage and oversee the work of external vendors. Coordinates with business analyst, IT and business areas, provides and reviews requirements and test results.

**Knowledge/Skills/Abilities**

- Independently manage and deliver Enrollment Enterprise-wide project initiatives from inception through delivery

- Subject matter expert of enrollment to Program Managers and Analyst and in functional areas (Inbound and Outbound)

- Communicate and collaborate with Operations, Health Plans and Leadership to analyze and transform needs and goals into functional requirements

- Develops, defines, and executes plans, schedules, and deliverables. Monitors programs from initiation through delivery

- Identify root cause, function and process improvement opportunities that are critical to effective outcome

- Lead programs to meet critical needs. Including but not limited to BRD reviews, logic changes, root cause analysis, etc.

- Works with operational leaders within the business to provide recommendations on opportunities for process improvements

- Collaborate with Other Teams within Molina to deliver End to End for any process within Enrollment Accounting Team

- Active collaborator responsible for operation projects and programs involving enrollment and eligibility

- Works with cross-functional teams and IT and business subject matter expert and to deliver products from design to completion

- Subject matter expert of enrollment and provides knowledge and feedback to ensure regulatory and Addresses health plan concerns within Enrollment Operations

- Research, interpret, define and summarize enhancement recommendations

- Provides health plan requirement recommendations

- Responsible for managing deliverables, improving performance, training needs, support to other business units

- Strong business knowledge related to Medicaid and Medicare lines of business Reviews enrollment issue trends and provide long term solutions as needed

- Manages, creates and communicates status reports

- Ensures compliance with regulatory and company guidelines, including HIPAA compliance

- This position primarily focuses on project/program management related to the business projects, rather than technical application projects

- Focuses on process improvement, organizational change management, program management and other processes relative to the business

- Participate and lead brainstorming sessions to develop new concepts to build efficiencies

- Ability to run and analyze SQL queries to drive data driven solutions

**Job Qualifications**

**Required Education**

Bachelor's Degree or equivalent combination of education and experience

**Required Experience**

5-7 years

**Preferred Education**

Graduate Degree or equivalent combination of education and experience

**Preferred Experience**

7-9 years

**Preferred License, Certification, Association**

PMP or Six Sigma Black Belt certification

#PJCorp

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: $59,810.6 - $129,589.63 / ANNUAL

- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Senior Project Manager (SME - Enrollment)

JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to the care management function, and contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

**Essential Job Duties**

-  Facilitates administrative support including case assignment, member screening and scheduling, correspondence processing, data entry and telephone and clerical support for team facilitating care management related services for members.

-  Facilitates initial review of assigned case levels and assists in case management assignment to care managers.

-  Reviews data to identify principle member needs and works under the direction of the care manager to implement care plan.

-  Schedules member visits with care managers as needed.

-  Screens members according to Molina policies and processes and assists care management staff during process of identifying appropriate member services.

-  Coordinates required member services in accordance with member benefit plan.

-  Promotes communication both internally and externally to enhance effectiveness of care management services.

-  Processes member and provider correspondence.

Required Qualifications

-  At least 1 year of experience in an administrative support role in health care, or equivalent combination of relevant education and experience.

-  Strong attention to detail.

-  Problem-solving skills.

-  Working knowledge of Microsoft Office (Outlook, Word, Excel) or other comparable software.

-  Excellent customer service skills.

-  Time-management and organizational skills.

-  Strong verbal and written communication skills.

-  Microsoft Office suite/applicable software program(s) proficiency.

**Preferred Qualifications**

-  Certified Medical Assistant (CMA).

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: $14.9 - $29.06 / HOURLY

- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Care Management Processor

**JOB DESCRIPTION Job Summary**

Provides support for member housing and placement activities, including assisting members at risk of homelessness and members recently discharged from institutions with permanent housing options. Also promotes member self-sufficiency and integration into the community. Contributes to overarching strategy to provide quality and cost-effective member care.

**Essential Job Duties**

-  Works to identify appropriate residential options for members discharged from state/behavioral health institutions and members at risk of homelessness.

-  Understands specific needs of the member needing resources, identifying available options that are the most cost-effective, most integrated and meet desired outcomes.

-  Assists with advocacy efforts related to broad-based solutions to help reduce barriers for members to access affordable housing.

-  Provides a variety of office and field activities to manage and monitor rapid re-housing/ transition-in-place programs for members.

-  Conducts intake interviews and assesses housing barriers of members experiencing homelessness to determine member housing and service needs, goals and eligibility.

-  Assists members with development of a strength-based, solution-focused individualized goal and action plan that promotes permanent housing and self-sufficiency.

-  Develops an effective, timely referral network for members to ensure ongoing direction and support as needed (e.g., community agencies for assistance with budget counseling and education).

-  Provides resources for mediation and advocacy with landlords on behalf of members to develop workable plans to obtain and/or maintain housing.

-  Participates in housing collaborative and other housing outreach events with the purpose of expanding the resource base.

-  Creates and maintains consistent communication channels, both verbal and written, between involved parties (e.g., tenant, landlord, referral source, collaborating agencies and public housing authorities).

-  Participates in the interdisciplinary care team (ICT) for members needing supportive housing services.

-  Provides information and referral assistance regarding available support from appropriate social service agencies and/or community programs by maintaining a housing resource guide.

-  Conducts proactive follow-up home visits with members to ensure stability and further progress towards self-sufficiency, which may include support, advocacy, reducing isolation, listening, problem-solving and identification of resources to assist with reintegration into the community.

-  Maintains accurate daily log records, monthly outcome reports and files for each member; collects and reports program data as required.

-  5-25% local travel may be required (based upon state/contractual requirements).

**Required Qualifications**

-  At least 2 years experience working with underserved or special needs populations with varied health, economic and educational circumstances, and experience with affordable housing and/or related community resources/social services, or equivalent combination of relevant education and experience.

-  Community Health Worker (CHW) may be required in some states (dependent upon state/contractual requirements).

-  Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements.

-  Knowledge of applicable state and federal guidelines/regulations (e.g., the fair housing act and the rights of people with disabilities under section 504 of the rehabilitation act of 1973).

-  Ability to prioritize and manage multiple deadlines.

-  Excellent organizational, problem-solving and critical-thinking skills.

-  Excellent verbal and communication skills.

-  Microsoft Office suite/applicable software program(s) proficiency.

**Preferred Qualifications**

-  Community Health Worker (CHW) certification.

-  Certified Medical Assistant (CMA).

-  Bilingual (based on community need).

-  Familiarity with health care systems/processes (ex: National Committee for Quality Assurance (NCQA) and InterQual.)

-  Knowledge of community-specific culture.

-  Experience working with persons with behavioral health/substance abuse issues and/or homelessness.

-  Experience developing care management plans.

#PJHPO2

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: $19.84 - $38.69 / HOURLY

- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Housing Specialist (Must Reside in Florida)

JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to the care management function, and contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

**Essential Job Duties**

-  Facilitates administrative support including case assignment, member screening and scheduling, correspondence processing, data entry and telephone and clerical support for team facilitating care management related services for members.

-  Facilitates initial review of assigned case levels and assists in case management assignment to care managers.

-  Reviews data to identify principle member needs and works under the direction of the care manager to implement care plan.

-  Schedules member visits with care managers as needed.

-  Screens members according to Molina policies and processes and assists care management staff during process of identifying appropriate member services.

-  Coordinates required member services in accordance with member benefit plan.

-  Promotes communication both internally and externally to enhance effectiveness of care management services.

-  Processes member and provider correspondence.

Required Qualifications

-  At least 1 year of experience in an administrative support role in health care, or equivalent combination of relevant education and experience.

-  Strong attention to detail.

-  Problem-solving skills.

-  Working knowledge of Microsoft Office (Outlook, Word, Excel) or other comparable software.

-  Excellent customer service skills.

-  Time-management and organizational skills.

-  Strong verbal and written communication skills.

-  Microsoft Office suite/applicable software program(s) proficiency.

**Preferred Qualifications**

-  Certified Medical Assistant (CMA).

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: $16.6 - $30.52 / HOURLY

- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**Job Description**

Job Summary

Provides support for dental specific member care coordination activities, including referrals, scheduling and other administrative activities. Contributes to overarching strategy to provide quality and cost-effective member care.

**Essential Job Duties**

-  Conducts telephonic outreach to members who may need dental services coordination assistance.

-  Verifies eligibility, enrollment history, demographic data, primary care physician and current health status of members.

-  Assesses member needs for possible handoff to ongoing care management.

-  Makes recommendations and/or referrals based on assessment and screening findings.

-  Provides assistance and education of available dental related benefits and providers.

-  Assists members in locating appropriate providers and/or making appointments as applicable.

-  Accurately completes and maintains documentation related to member interactions, assessments/screener and provider contacts.

-  Creates and completes timely follow-up with members.

-  Establishes relationships with members, providers and interdisciplinary care team members.

-  Reviews reports to identify members that may need dental coordination assistance.

-  Collaborates with teams including healthcare services to facilitate coordination of member care related to dental services.

-  Provides general administrative support related to coordination of member dental services including: accessing appointments, translation services and transportation assistance.

**Required Qualifications**

-  At least 2 years experience in health care, preferably in a dental environment, or equivalent combination of relevant education and experience.

-  Knowledge of medical terminology.

-  Ability to gather information and coordinate workflows.

-  Effective time-management and organizational skills.

-  Critical thinking and active listening skills.

-  Decision-making and problem-solving skills.

-  Ability to work independently and within a team environment.

-  Excellent verbal and written communication skills.

-  Microsoft Office suite/applicable software program(s) proficiency.

**Preferred Qualifications**

-  Previous dental, pediatric, and/or managed care experience.

#PJCorp

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: $16.4 - $31.97 / HOURLY

- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Coordinator, Dental Program - Pediatrics/Adolescents FL only

**JOB DESCRIPTION Job Summary**

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.

**Essential Job Duties**

-  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.

#PJCorp

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: $15.58 - $31.97 / HOURLY

- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Adjudicator, Provider Claims-KY-On the phone-closing shift

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