Molina Healthcare

Manager, Health Plan Provider Engagement (Remote in MS)

Molina Healthcare · Full Time · 3 hours ago

Molina Healthcare

🌎 United States 💵 $65792 - $142K per year ⭐ 5-10 yrs exp 💼 Healthcare

Leads a team responsible for health plan provider engagement to drive value-based care strategies and quality improvement. Manages performance goals for providers to ensure risk adjustment targets and health outcomes are met.

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Senior Specialist, Health Plan Member & Community Interventions (Remote in MS)

Molina Healthcare · Full Time · 3 hours ago

Molina Healthcare

🌎 United States 💵 $49430 - $107K per year ⭐ 2-5 yrs exp 💼 Healthcare

Provides senior-level support for clinical quality member interventions across various lines of business including Medicare and Medicaid. Responsible for implementing evidence-based strategies, monitoring performance outcomes, and building relationships with community-based organizations.

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Senior Specialist, Health Plan Provider Engagement (Remote in MS)

Molina Healthcare · Full Time · 3 hours ago

Molina Healthcare

🌎 United States 💵 $49430.25 - $107K per year ⭐ 2-5 yrs exp 💼 Healthcare

Implement health plan provider engagement strategies to drive quality and risk adjustment outcomes through data-driven coaching. Manage engagement plans for Tier 1 and Tier 2 providers to improve Medicaid, Medicare, and Marketplace performance.

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(RN) Appeals Medical Review Nurse - REMOTE

Molina Healthcare · Full Time · 3 hours ago

Molina Healthcare

🌎 United States 💵 $26.14 - $56.64 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for reviewing medical documentation to ensure medical necessity and appropriate level of care using MCG/InterQual and regulatory guidelines. The role involves facilitating appeals for denied authorizations and validating medical records for correct provider reimbursement.

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Analyst, Workforce Scheduling - Remote

Molina Healthcare · Full Time · 4 hours ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Provides analytical support for workforce management to ensure optimal staffing levels and coverage based on business needs. Responsible for forecasting call volumes, managing headcount requirements, and developing capacity templates.

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Analyst, Provider Configuration (Remote)

Molina Healthcare · Full Time · 4 hours ago

Molina Healthcare

🌎 United States 💵 $49430.25 - $107K per year ⭐ 2-5 yrs exp 💼 Others

Responsible for the accurate maintenance and synchronization of provider information across claims and provider databases. The role involves auditing records for financial accuracy and generating regulatory compliance reports.

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Remote Care Review Clinician (RN/LPN)- NY License required

Molina Healthcare · Full Time · 6 hours ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for reviewing clinical service requests to ensure medical necessity and alignment with established guidelines and regulations. Collaborates with multidisciplinary teams to provide cost-effective care and manage prior authorizations.

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Senior Data Scientist - GenAI/Agentic AI - Remote

Molina Healthcare · Full Time · 8 hours ago

Molina Healthcare

🌎 United States 💵 $87568 - $189K per year ⭐ 5-10 yrs exp 💼 Software Development

Design and deploy autonomous, LLM-powered agentic systems and RAG pipelines to solve complex business problems. Focus on tool orchestration, model optimization, and establishing evaluation frameworks for production-grade GenAI applications.

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Lead Analyst, Healthcare Analytics (Data Stewardship & Enterprise Reporting) – Remote

Molina Healthcare · Full Time · 2 days ago

Molina Healthcare

🌎 United States 💵 $65791.66 - $142K per year ⭐ 5-10 yrs exp 💼 Software Development

The Lead Analyst acts as a data steward responsible for designing and prototyping Medical Economics data assets and translating complex business concepts into structured logic. They partner with stakeholders to define data requirements and ensure data quality and traceability across systems.

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Manager, Process Improvement & Operational Excellence-Salesforce (Remote)

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States 💵 $72370.82 - $156K per year ⭐ 5-10 yrs exp 💼 Software Development

Leads a team focused on process improvement initiatives to increase operational efficiency and customer satisfaction within healthcare operations. Manages end-to-end workflows, establishes KPIs, and partners with IT and Product teams to optimize system performance.

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Analyst, Data & Analytics (Remote)

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Software Development

Conducts research and analysis on healthcare and operational data to support decision-making and cost-containment strategies. Develops and maintains reports, dashboards, and analytical tools using SQL and BI platforms to improve business performance.

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Business Relationship Manager, IT - Health Plan to IT Liason - Remote

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

Acts as a strategic liaison between business partners and IT to align technology capabilities with business needs and priorities. Manages demand intake, documents requirements, and oversees cross-functional projects to improve IT value perception and operational efficiency.

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Care Review Clinician (RN) Remote

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The clinician performs clinical member services reviews to ensure services are medically necessary and align with established guidelines. They manage the transition of Medicaid members from inpatient care to discharge locations while collaborating with multidisciplinary teams.

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Pre-Pay Dispute Coding Analyst (Inpatient and Outpatient Coding Preferred) - REMOTE

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States 💵 $19.64 - $42.55 per hour ⭐ 2-5 yrs exp 💼 Others

Investigates and resolves provider denial coding disputes by examining medical records and claims to ensure billing accuracy. Collaborates with internal departments to track coding errors and refine departmental processes in alignment with regulations.

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Manager, Special Investigative Unit-NY (remote)

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States 💵 $73102 - $171K per year ⭐ 5-10 yrs exp 💼 Others

Leads the Special Investigative Unit to prevent and detect violations of laws and regulations, protecting the business from fraudulent practices. Oversees the referral intake process, manages investigations, and collaborates with leadership to maintain fraud, waste, and abuse plans.

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Senior Engineer, EIS - SASE & Data Security - Remote

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States 💵 $79607.91 - $172K per year ⭐ 5-10 yrs exp 💼 Software Development

The role involves technical ownership of the SASE platform and enterprise data protection capabilities to ensure secure access and regulatory compliance. Responsibilities include designing secure access policies, managing vendor escalations, and overseeing endpoint recovery technologies.

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Senior Analyst, Finance (Financial Reporting & SQL) - REMOTE

Molina Healthcare · Full Time · 4 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Software Development

Provides senior-level financial analysis, reporting, and forecasting to support business decisions and the financial management of the IL health plan. Responsibilities include managing the monthly close process, developing financial models, and handling regulatory reporting.

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Care Review Clinician (RN) Remote

Molina Healthcare · Full Time · 4 days ago

Molina Healthcare

🌎 United States 💵 $23.76 - $51.49 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The clinician assesses Medicare members to ensure medically necessary services and a successful transition from inpatient care to home or nursing facilities. They analyze clinical service requests against evidence-based guidelines and collaborate with multidisciplinary teams to optimize member outcomes.

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Project Manager, PMO - Scrum Master - Remote

Molina Healthcare · Full Time · 4 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Product

Focuses on process improvement, organizational change management, and project management including estimating, scheduling, and costing. Responsible for developing detailed project plans and managing risks and obstacles for intermediate to large-scale projects.

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Supervisor, Payment Integrity (Remote)

Molina Healthcare · Full Time · 4 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Others

Leads and supervises the team responsible for payment integrity activities, including overpayment recovery and claims processing. Establishes operational standards and monitors production targets to ensure financial and regulatory compliance.

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Certified Coder (Risk Adjustment Experience) - REMOTE

Molina Healthcare · Full Time · 4 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Software Development

The Certified Coder will perform ongoing member medical chart reviews, abstracting and reporting ICD-10 and CPT diagnosis codes accurately. They will also provide training and education to the provider network regarding risk adjustment and coding updates.

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Health Plan Provider Contracts Manager - Complex

Molina Healthcare · Full Time · 4 days ago

Molina Healthcare

🌎 United States 💵 $83252 - $163K per year ⭐ 5-10 yrs exp 💼 Healthcare

Leads complex contracting activities with strategically critical provider groups, including hospitals and IPAs, to ensure network adequacy and financial performance. Negotiates value-based payment models and manages the optimization of provider relationships and reimbursement structures.

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Senior Specialist, Coding (Remote)

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

🌎 United States 💵 $49430.25 - $107K per year ⭐ 2-5 yrs exp 💼 Others

Provides senior-level coding expertise to ensure compliance and minimize risks related to billing and fraudulent practices. Responsible for performing chart reviews, facilitating physician education on risk adjustment, and coordinating CMS data validation activities.

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Associate Analyst, Provider Configuration (Remote)

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

🌎 United States 💵 $16.23 - $35.17 per hour ⭐ 0-2 yrs exp 💼 Others

Provides entry-level analyst support for provider configuration by maintaining critical provider information across claims and provider databases. Ensures data accuracy and synchronization to support contracting, network management, and credentialing processes.

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Executive Assistant - Remote

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

🌎 United States 💵 $24 - $46.81 per hour ⭐ 5-10 yrs exp 💼 Virtual Assistant

Provides high-level administrative support to an Executive and division team, including calendar management and correspondence. Responsible for preparing reports, coordinating travel, and serving as a recording secretary for committees.

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Care Management Processor (Central Time Zone Hours) - REMOTE

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

🌎 United States 💵 $17.05 - $30.52 per hour ⭐ 0-2 yrs exp 💼 Others

Provides non-clinical administrative support to the care management function, including case assignment, member screening, and scheduling. Facilitates communication and processes correspondence to support integrated delivery of care for members.

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Specialist, Waiver Support - Remote Must reside in Texas

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

🌎 United States 💵 $14.9 - $29.06 per hour ⭐ 0-2 yrs exp 💼 Support

Provides non-clinical operational support for member waiver coordination and facilitates communication between state program units and long-term services. Responsible for tracking referrals, monitoring assessments, and ensuring Medicaid and waiver eligibility for members.

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Care Review Clinician (RN) - (IL Nursing license)

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for performing utilization reviews and clinical determinations to ensure services are medically necessary and cost-effective. Collaborates with multidisciplinary teams to manage member care and ensure compliance with state and federal regulations.

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Care Review Clinician (RN) - (IL Nursing license)

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The clinician is responsible for performing utilization reviews to ensure services are medically necessary and align with clinical guidelines. They analyze service requests, determine prior authorizations, and collaborate with multidisciplinary teams to optimize member outcomes.

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Care Management Processor - REMOTE

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

🌎 United States 💵 $13.41 - $29.06 per hour ⭐ 0-2 yrs exp 💼 Others

Provides non-clinical administrative support to the care management function, including case assignment, member screening, and scheduling. Facilitates communication and processes correspondence to ensure integrated delivery of quality member care.

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Care Management Processor - STARS

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

🌎 United States 💵 $14.9 - $29.06 per hour ⭐ 0-2 yrs exp 💼 Others

Provides non-clinical administrative support to the care management function, including case assignment, member screening, and scheduling. Facilitates communication and processes correspondence to support integrated delivery of care for members.

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Senior Engineer, Big Data - Payment Integrity/Databricks - Remote

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

🌎 United States 💵 $79607.91 - $172K per year ⭐ 5-10 yrs exp 💼 Software Development

Responsible for the architecture, design, and implementation of Big Data management solutions using Cloudera or Hortonworks. Focuses on building scalable data ingestion processes, data models for analytics, and leading a team of data professionals.

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Pharmacy CSR, Remote

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

🌎 United States 💵 $11.09 - $24.02 per hour ⭐ 0-2 yrs exp 💼 Support

Provide customer service support for inbound and outbound pharmacy calls from members, providers, and pharmacies. Coordinate pharmacy prior authorization requests and explain plan benefit information and coverage determinations.

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Program Director (Direct Payment Program Experience Preferred) - REMOTE

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

🌎 United States 💵 $80412 - $156K per year ⭐ 5-10 yrs exp 💼 Product

Responsible for managing internal business projects and programs, overseeing governance across operational and strategic portfolios. The role involves directing schedules, budgets, and external vendors while presenting updates to C-level executives.

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Senior Architect, Information Systems - Databricks - Remote

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

🌎 United States 💵 $96325.57 - $208K per year ⭐ 5-10 yrs exp 💼 Software Development

Lead enterprise data and analytics transformation initiatives by designing scalable, secure, and AI-ready data platforms using Databricks. Drive architecture strategy, platform modernization, and provide hands-on leadership from design through implementation.

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(RN) Remote Care Review Clinician - Utilization Review

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

🌎 United States 💵 $25.08 - $51.49 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for verifying that clinical services are medically necessary and align with established guidelines and insurance policies. The role involves analyzing service requests, processing prior authorizations, and collaborating with multidisciplinary teams to ensure cost-effective member care.

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Lead, Healthcare Services (Remote in Florida)

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

🌎 United States 💵 $29.05 - $56.64 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Provides lead-level clinical support to healthcare services teams, coordinating integrated member care across various clinical programs. Responsibilities include supervising staff workload, resolving operational issues, and ensuring compliance with quality and productivity standards.

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Health Plan Provider Contracts Manager - Complex

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

🌎 United States 💵 $69447 - $142K per year ⭐ 5-10 yrs exp 💼 Healthcare

Lead complex contracting activities with strategically critical provider groups, including hospitals and behavioral health organizations. Manage the execution and optimization of value-based contracts while ensuring network adequacy and financial performance.

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National Network Performance Director

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

🌎 United States 💵 $87568 - $189K per year ⭐ 5-10 yrs exp 💼 Others

Leads the development and operationalization of scalable cost of care and network performance initiatives across the enterprise. This includes maturing unvetted ideas into business cases and creating standardized playbooks for health plan execution.

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Program Manager, Healthcare Services (Remote)

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

🌎 United States 💵 $65791.66 - $142K per year ⭐ 5-10 yrs exp 💼 Product

Provides leadership and subject matter expertise to design, execute, and evaluate healthcare services programs while ensuring regulatory compliance. Focuses on process improvement, creating business requirements documents, and collaborating with cross-functional teams to deliver quality member care.

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Health Plan Provider Relations Manager (Remote in Iowa)

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

🌎 United States 💵 $57394 - $117K per year ⭐ 5-10 yrs exp 💼 Healthcare

Provides leadership and subject matter expertise for health plan provider relations, focusing on network development and adequacy. Serves as the primary contact for contracted providers to ensure satisfaction, compliance with policies, and effective issue resolution.

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Representative, Health Plan Provider Relations (Remote)

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

🌎 United States 💵 $19.84 - $38.69 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Serves as the primary point of contact between the health plan and contracted providers to ensure satisfaction and compliance with policies. Manages network development, conducts site visits, and delivers training to improve coordination and partnership.

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Actuarial Consultant (Finance & Actuarial) - REMOTE

Molina Healthcare · Full Time · 7 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Finance

Provides expert actuarial consultancy to identify risks, estimate liabilities, and establish premium rates. Supports financial analysis, reporting, and the creation of actuarial opinions and state reporting requirements.

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Medical Records Collector (Remote)

Molina Healthcare · Full Time · 7 days ago

Molina Healthcare

🌎 United States 💵 $20.34 - $30.39 per hour ⭐ 0-2 yrs exp 💼 Healthcare

The role involves outreaching to providers via various channels to collect medical records for HEDIS data collection and audit processes. Responsibilities include loading records into internal databases and providing project management support to leadership.

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Delegation Oversight Nurse (LPN) - Utilization Management Experience Required

Molina Healthcare · Full Time · 7 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Oversees delegated activities to ensure compliance with NCQA, CMS, and state Medicaid requirements. Coordinates pre-delegation assessments, monitors performance reports, and develops corrective action plans for identified deficiencies.

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Care Review Clinician (BH Licensed) Remote

Molina Healthcare · Full Time · 11 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Responsible for reviewing behavioral health clinical service requests to ensure medical necessity and compliance with regulations. Collaborates with multidisciplinary teams to manage care delivery and optimize member outcomes.

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Business Analyst, Provider Network (Salesforce Needed) Remote

Molina Healthcare · Full Time · 11 days ago

Molina Healthcare

🌎 United States 💵 $44936.59 - $97362.61 per year ⭐ 2-5 yrs exp 💼 Software Development

Responsible for the intake and interpretation of regulatory and functional requirements related to coverage and reimbursement to support system solutions. This includes coordinating with stakeholders and maintaining requirement documents to ensure alignment with health plan and regulatory baselines.

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Consultant, Medical Economics (Cost Trend & Strategy) - REMOTE

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

🌎 United States 💵 $72370.82 - $156K per year ⭐ 5-10 yrs exp 💼 Healthcare

Provides subject matter expertise in medical economics to analyze cost drivers and identify financial risks and opportunities. Collaborates with clinical and network leadership to deliver data-driven insights and improve financial performance.

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Program Manager, Medicare Stars & Quality Improvement (Remote in Michigan)

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Product

Lead and manage Medicare Stars quality improvement programs and initiatives across the enterprise to improve Star ratings. Collaborate with cross-functional teams to design, implement, and measure the outcomes of quality improvement projects.

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Program Manager, Medicare Stars & Quality Improvement (Remote in Illinois)

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Product

Lead and manage Medicare Stars quality improvement programs and initiatives across the enterprise to improve Star ratings. Collaborate with cross-functional teams to design, implement, and measure the outcomes of quality improvement projects.

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Program Manager, Medicare Stars & Quality Improvement (Remote in Kentucky)

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Product

Lead and manage Medicare Stars quality improvement programs and initiatives to improve health plan ratings. Collaborate with cross-functional teams to design, implement, and measure the outcomes of QI projects.

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Program Manager, Medicare Stars & Quality Improvement (Remote in Washington)

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Product

Lead and manage Medicare Stars quality improvement programs and initiatives across the enterprise to improve Star ratings. Collaborate with cross-functional teams to design, implement, and measure the outcomes of quality improvement projects.

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Program Manager, Medicare Stars & Quality Improvement (Remote in California)

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

🌎 United States 💵 $84067 - $163K per year ⭐ 5-10 yrs exp 💼 Product

Lead and manage Medicare Stars quality improvement programs and initiatives across the enterprise to improve Star ratings. Collaborate with cross-functional teams to design, implement, and measure the outcomes of QI projects and performance standards.

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Manager, Healthcare Services (Remote in FL)

Molina Healthcare · Full Time · 13 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

Leads a multidisciplinary team of healthcare professionals to ensure quality, cost-effective member care through integrated delivery and coordination. Manages staff performance, ensures regulatory compliance, and oversees daily healthcare service activities and productivity.

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Analyst, National Quality Analytics & Performance Improvement (Remote)

Molina Healthcare · Full Time · 13 days ago

Molina Healthcare

🌎 United States 💵 $49430.25 - $107K per year ⭐ 2-5 yrs exp 💼 Software Development

Provides analytical support for enterprise risk and quality reporting, specifically focusing on HEDIS auditing and performance metric tracking. Collaborates cross-functionally to develop reporting solutions and conduct root-cause analysis on complex healthcare data sets.

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Senior Abstractor, National HEDIS/Quality Improvement (Remote)

Molina Healthcare · Full Time · 13 days ago

Molina Healthcare

🌎 United States 💵 $19.64 - $42.55 per hour ⭐ 2-5 yrs exp 💼 Others

Provides senior-level support for HEDIS and quality improvement data collection and medical record abstraction. Facilitates record reviews, coordinates with auditors and vendors, and provides mentorship to the abstraction team.

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Pharmacy CSR Bilingual Spanish (Remote, Must Live in Florida)

Molina Healthcare · Full Time · 13 days ago

Molina Healthcare

🌎 United States ⭐ 0-2 yrs exp 💼 Support

Provide customer service support for inbound and outbound pharmacy calls from members, providers, and pharmacies. Coordinate pharmacy prior authorization requests and explain plan benefit information and CMS policies.

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Director, Value-Based Programs (Remote in FL)

Molina Healthcare · Full Time · 14 days ago

Molina Healthcare

🌎 United States ⭐ 10+ yrs exp 💼 Others

Leads the development and implementation of value-based strategies and programs to improve risk adjustment revenue and financial objectives. Manages a high-performance team and collaborates with leadership to design contracts and monitor performance via internal dashboards.

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Senior Business Analyst

Molina Healthcare · Full Time · 14 days ago

Molina Healthcare

🌎 United States 💵 $49430.25 - $107K per year ⭐ 2-5 yrs exp 💼 Software Development

Provides senior-level support for the intake and interpretation of regulatory and functional requirements related to coverage and reimbursement. Coordinates with stakeholders to translate business needs into application requirements and ensures alignment across health plans.

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Care Manager (BH Licensed) (Must Reside in Mississippi)

Molina Healthcare · Full Time · 14 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Provides comprehensive behavioral health assessments and develops integrated care plans for members. Coordinates with multidisciplinary teams and conducts home or telephonic visits to monitor progress and ensure quality care.

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Director, Delegation Oversight Compliance - REMOTE

Molina Healthcare · Full Time · 14 days ago

Molina Healthcare

🌎 United States ⭐ 10+ yrs exp 💼 Legal

Leads the team responsible for multi-state delegation oversight to ensure compliance with state, federal, and NCQA requirements. Manages delegated vendor relationships, performance metrics, and audits to mitigate risk and optimize operational functions.

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Sr Data Analyst, Enrollment Research and Data Analytics (Remote)

Molina Healthcare · Full Time · 15 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Software Development

Analyze enrollment data across various lines of business to resolve data issues and ensure compliance with CMS and state regulations. Develop reporting tools, dashboards, and algorithms to monitor business performance and support executive decision-making.

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Lead Analyst, Provider and Facility Reimbursement (Remote)

Molina Healthcare · Full Time · 15 days ago

Molina Healthcare

🌎 United States 💵 $59810.6 - $129K per year ⭐ 5-10 yrs exp 💼 Others

The Lead Analyst manages complex provider and facility reimbursement methodologies, focusing on implementation, maintenance, and quality assurance for various health plan lines of business. They collaborate with IT and vendors to resolve pricing variances and provide subject matter expertise to support departmental goals.

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Sr Quality Improvement/HEDIS Spec, Health Plan Interventions (Remote In Ohio)

Molina Healthcare · Full Time · 15 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Lead quality improvement initiatives using QI science to support Medicare Stars measures and member intervention activities. Develop and implement evidence-based strategies to remove barriers to care and ensure compliance with NCQA and federal/state regulations.

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Remote DRG Clinical Validation Reviewer (Coding RN)

Molina Healthcare · Full Time · 17 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Performs focused clinical reviews of inpatient and outpatient claims to ensure coded diagnoses and procedures accurately reflect patient documentation. Develops evidence-based rationales to validate DRG assignments and identify billing inconsistencies to ensure reimbursement accuracy.

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Product Owner (Remote)

Molina Healthcare · Full Time · 17 days ago

Molina Healthcare

🌎 United States 💵 $65791 - $142K per year ⭐ 5-10 yrs exp 💼 Product

The Product Owner is responsible for maximizing the value of technical products by owning the product vision, backlog, and delivery outcomes. They serve as the primary bridge between business stakeholders and technical teams to ensure solutions align with enterprise strategy and regulatory requirements.

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Senior Specialist, PSOC Systems & Services (Remote)

Molina Healthcare · Full Time · 18 days ago

Molina Healthcare

🌎 United States 💵 $59810.6 - $129K per year ⭐ 5-10 yrs exp 💼 Others

Provides senior-level technical support and management for PSOC enterprise applications supporting physical security, business continuity, and emergency response. Collaborates with IT teams and stakeholders to implement system enhancements, maintain documentation, and provide user training.

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Auditor, Compliance (Remote)

Molina Healthcare · Full Time · 18 days ago

Molina Healthcare

🌎 United States 💵 $49430.25 - $107K per year ⭐ 2-5 yrs exp 💼 Finance

The role involves evaluating adherence to regulatory requirements and internal policies to identify compliance gaps. The auditor will perform ongoing audits, document findings, and recommend improvements to mitigate risks of fraudulent practices.

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Associate General Counsel

Molina Healthcare · Full Time · 18 days ago

Molina Healthcare

🌎 United States 💵 $96325 - $208K per year ⭐ 2-5 yrs exp 💼 Legal

Provides legal advisement on corporate governance, rights, and obligations while supporting Molina Healthcare's subsidiaries. Manages the drafting of corporate records and provides guidance to the corporate paralegal team.

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Associate Representative, Health Plan Provider Relations - Remote must reside in UT

Molina Healthcare · Full Time · 18 days ago

Molina Healthcare

🌎 United States 💵 $18.04 - $35.17 per hour ⭐ 0-2 yrs exp 💼 Healthcare

Provides entry-level support for health plan provider relations, focusing on network development, adequacy, and provider education. Serves as the primary point of contact for contracted providers to resolve inquiries regarding claims and eligibility.

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CSR Medication Therapy Management Services (Remote)

Molina Healthcare · Full Time · 19 days ago

Molina Healthcare

🌎 United States ⭐ 0-2 yrs exp 💼 Support

Provide customer service support for inbound and outbound Medication Therapy Management pharmacy calls from members, providers, and pharmacies. Educate members on medication adherence and support pharmacists with comprehensive medication reviews and case preparation.

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Senior Analyst, National Quality Analytics & Performance (Remote)

Molina Healthcare · Full Time · 20 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Software Development

Provides senior-level analyst support for enterprise risk and quality reporting, specifically focusing on HEDIS auditing and performance metric tracking. Collaborates cross-functionally to design reporting solutions and conduct root-cause analysis on complex healthcare data sets.

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(RN) Remote Care Review Clinician- Utilization Review

Molina Healthcare · Full Time · 20 days ago

Molina Healthcare

🌎 United States 💵 $23.76 - $51.49 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for verifying that clinical services are medically necessary and align with established guidelines and insurance policies. The role involves analyzing service requests, processing prior authorizations, and collaborating with multidisciplinary teams to ensure cost-effective member care.

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Analyst, Health Plan Risk & Quality Reporting (Remote in FL)

Molina Healthcare · Full Time · 20 days ago

Molina Healthcare

🌎 United States 💵 $49930 - $97363 per year ⭐ 2-5 yrs exp 💼 Healthcare

Provides analyst support for health plan risk and quality reporting, focusing on HEDIS and risk adjustment for various plan types. Develops custom reports and performs root-cause analysis to track outcomes and improve quality performance.

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Health Plan Provider Relations Manager (Remote in IL)

Molina Healthcare · Full Time · 20 days ago

Molina Healthcare

🌎 United States 💵 $63435 - $123K per year ⭐ 5-10 yrs exp 💼 Healthcare

Provides leadership and subject matter expertise for health plan provider relations, focusing on network development and adequacy. Serves as the primary contact for contracted providers to ensure compliance with policies and improve partnership coordination.

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AVP, Enterprise Architecture (AI/ML/Azure Cloud) - REMOTE

Molina Healthcare · Full Time · 25 days ago

Molina Healthcare

🌎 United States ⭐ 10+ yrs exp 💼 Software Development

The AVP Enterprise Architecture designs and communicates the shared architectural vision and standards to drive industry-leading capabilities. This role leads teams in developing conceptual, logical, and physical designs while transitioning legacy systems to PAAS and SAAS models.

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