Provides non-clinical administrative support to the care management team, including case assignment, member screening, and data entry. Facilitates communication between internal and external stakeholders to ensure effective delivery of care services.
The Associate Analyst is responsible for organizing data from multiple sources to produce reports, dashboards, and analyses related to healthcare utilization and business performance. They also support projects, regulatory requests, and initiatives aimed at improving data quality and reporting workflows.
Leads and manages a team responsible for the submission and resolution of member and provider appeals and grievances in accordance with CMS standards. Oversees business process audits, stakeholder communication, and the preparation of reports for committee presentations.
Provide level II support to members and providers via phone, chat, and email to resolve issues and improve engagement. Document all interactions accurately while meeting performance goals for quality, attendance, and resolution.
The Senior Analyst provides financial support for Medicare lines of business by overseeing performance, forecasting, and medical cost trends. They also evaluate capitation and value-based care arrangements to deliver actionable insights for executive leadership.
The Senior Examiner evaluates claims for incorrect coding, fraud, and processing errors while managing a complex caseload. They also monitor medical treatments and ensure compliance with state and federal regulations.
The Care Manager provides support for LTSS-specific activities and coordinates integrated delivery of member care across the continuum. They are responsible for completing comprehensive member assessments, developing care plans, and monitoring member progress toward desired health outcomes.
Provides administrative support to the care management team, including case assignment, member screening, and data entry. Facilitates communication between internal and external stakeholders to ensure effective delivery of member care services.
The Lead Adjudicator coordinates daily claims workflow, monitors staff performance, and manages escalations to ensure adherence to quality and productivity standards. They also serve as a subject matter expert, providing training, troubleshooting complex claims, and collaborating with stakeholders to improve processes.
The IRIS Consultant builds relationships with participants to help them navigate the Medicaid long-term care program and achieve their personal goals. They are responsible for developing customized care plans, managing budgets, and documenting all activities within the program's data system.
The RN will provide oversight, assessment, and guidance to participants in the IRIS Self-Directed Personal Care program. Responsibilities include developing person-centered care plans, conducting home visits, and providing training to participants and care providers.
Leads and directs teams responsible for health plan quality management, performance improvement, and regulatory compliance activities. Oversees the implementation of quality strategies, manages audits, and ensures adherence to NCQA, federal, and state requirements.
Leads application engineering teams delivering and supporting cloud-native, AI-enabled solutions on Microsoft Azure for healthcare payer operations, including Medicare and Medicaid programs. Sets architecture and quality standards, oversees implementation and integrations, manages vendor and stakeholder relationships, and develops a team focused on end-to-end business ownership.
Directs and oversees multidisciplinary healthcare services teams including utilization management, care management, and behavioral health programs. Collaborates with senior leadership to establish strategic plans and ensures the delivery of quality, cost-effective member care.
Conducts onsite, virtual, and desktop facility site reviews to ensure compliance with local, state, and federal requirements. Collaborates with providers to offer education, resources, and tools while documenting review outcomes in designated databases.
The specialist provides administrative support for facility site review activities, including document management, scheduling, and data entry. They also facilitate communication with providers and contribute to the development of departmental workflows and training materials.
The Care Manager provides comprehensive care coordination and support for members with high-need potential, including developing care plans and facilitating interdisciplinary team meetings. They are responsible for conducting in-person home visits, monitoring member progress, and ensuring the delivery of quality, cost-effective services.
The Care Manager provides comprehensive care coordination and LTSS-specific activities for members with high-need potential. They are responsible for developing care plans, conducting member assessments, and facilitating interdisciplinary care team meetings to ensure quality and cost-effective outcomes.
The specialist will implement provider engagement strategies to drive quality and risk adjustment outcomes for Tier 2 and Tier 3 providers. They will coach providers, facilitate data exchanges, and manage action plans to improve performance and health outcomes.
The Care Manager provides support for long-term services and supports (LTSS) by coordinating integrated care for members with high-need potential. They are responsible for conducting comprehensive assessments, developing care plans, and monitoring member progress toward desired health outcomes.
The Senior Engineer will design and build enterprise-grade big data solutions on Microsoft Azure to support Medicare/Medicaid operations. They will collaborate cross-functionally to translate business requirements into scalable, AI-driven data architectures.
The Senior Program Manager leads end-to-end program delivery, including design, implementation, and governance across cross-functional business units. They are responsible for driving performance measurement, managing budgets, and ensuring organizational alignment through effective stakeholder engagement and process improvement.
The IRIS Consultant builds relationships with participants to help them navigate the Medicaid long-term care program and achieve their personal goals. They are responsible for developing customized care plans, managing budgets, and documenting all activities within the program's data system.
The Care Manager coordinates long-term services and supports for members by developing and monitoring individualized care plans. They conduct comprehensive assessments, facilitate interdisciplinary team meetings, and ensure member health and welfare through proactive care coordination.
The Care Manager provides support for LTSS-specific activities and coordinates integrated care for members with high-need potential. Responsibilities include conducting comprehensive member assessments, developing care plans, and facilitating interdisciplinary care team meetings.
The Care Manager provides care coordination and support for members with high-need potential by developing and monitoring comprehensive care plans. They conduct member assessments, facilitate interdisciplinary team meetings, and ensure the delivery of quality, cost-effective services.
Conduct comprehensive member assessments, coordinate waiver enrollment, and develop and monitor individualized care plans with members, caregivers, and healthcare professionals. Coordinate integrated LTSS and behavioral health services, authorize appropriate waiver services, address barriers to care, and support member safety and progress toward goals.
Conduct member assessments, coordinate waiver enrollment, develop and monitor care plans, and authorize appropriate waiver services. Coordinate integrated care with members, caregivers, providers, interdisciplinary teams, and community resources while addressing barriers and preventing critical incidents.
The Care Manager provides comprehensive care coordination and LTSS-specific activities for members with high-need potential. They are responsible for developing care plans, conducting home visits, and facilitating interdisciplinary care team meetings to ensure quality and cost-effective outcomes.
Conduct comprehensive member assessments and coordinate LTSS care, including waiver enrollment, service planning, authorizations, and ongoing monitoring. Collaborate with members, caregivers, clinicians, and interdisciplinary teams to address barriers, integrate services, and support member health, safety, and care goals.
Conduct comprehensive member assessments and coordinate long-term services and supports, including waiver enrollment, service authorization, and individualized care planning. Monitor care plan outcomes, facilitate interdisciplinary collaboration, address barriers to care, and support member health and safety through local visits and ongoing coordination.
Provides diagnosis-related nutrition education and individualized dietary plans, consulting with members, families, physicians, and multidisciplinary teams. Monitors and documents nutritional status and care plan progress, develops success measures, and coaches members toward self-management goals.
The engineer will provide senior-level support for enterprise infrastructure, including cloud environments, automation frameworks, and system reliability. They will collaborate with cross-functional teams to design, deploy, and maintain scalable technical solutions while ensuring compliance with security and industry standards.
Leads and manages a regional team responsible for multi-state delegation oversight activities to ensure compliance with state, federal, and NCQA requirements. Collaborates with internal business owners to manage delegated entity performance, including audits, corrective action plans, and risk monitoring.
Conduct member assessments and coordinate waiver enrollment, care plans, service authorizations, and ongoing monitoring for people with long-term support needs. Collaborate with members, caregivers, providers, and interdisciplinary teams to integrate services, address barriers, and promote member health and progress toward goals.
The Care Manager coordinates long-term services and supports for members, developing and monitoring individualized care plans to ensure quality outcomes. They conduct comprehensive assessments, facilitate interdisciplinary team meetings, and provide ongoing support to address medical, social, and financial barriers.
The Care Manager provides support for LTSS-specific activities and coordinates integrated care for members with high-need potential. They are responsible for conducting comprehensive assessments, developing care plans, and monitoring member progress toward desired health outcomes.
The Care Manager coordinates integrated long-term services and supports for members, developing and monitoring individualized care plans. They conduct comprehensive assessments, facilitate interdisciplinary team meetings, and ensure members receive quality, cost-effective care.
Conduct comprehensive member assessments, coordinate waiver enrollment and services, and develop and monitor individualized care plans with members, caregivers, and healthcare professionals. Coordinate integrated LTSS and behavioral health services, authorize appropriate waiver services, address barriers to care, and support member health, safety, and progress toward goals.
The Director leads and directs teams responsible for planning and implementing healthcare quality improvement initiatives and education programs. They oversee compliance with NCQA accreditation, HEDIS performance improvement, and federal/state quality intervention rules.
The Care Manager provides care coordination and support for members with high-need potential, ensuring quality and cost-effective care. Responsibilities include conducting comprehensive member assessments, developing care plans, and facilitating interdisciplinary care team meetings.
Provides support for care management and coordination activities for members with high-need potential across the continuum of care. Develops and monitors care plans while collaborating with multidisciplinary teams to ensure quality and cost-effective member outcomes.
The Care Manager completes comprehensive member assessments and develops integrated care plans to support long-term services and supports. They collaborate with multidisciplinary teams to monitor member progress, authorize services, and ensure quality, cost-effective care delivery.
The Program Manager is responsible for managing program controls, documentation, budgets, and governance frameworks across functional areas. They also track performance metrics, facilitate stakeholder collaboration, and ensure the successful adoption of program best practices.
The Product Owner is responsible for the end-to-end product lifecycle, including defining the product vision, managing the backlog, and ensuring alignment with business and regulatory outcomes. They serve as the primary bridge between business stakeholders and technical delivery teams to ensure solutions are feasible, scalable, and supportable.
The Care Manager provides support for LTSS-specific activities and coordinates integrated care for members with high-need potential. Responsibilities include conducting comprehensive assessments, developing care plans, and facilitating interdisciplinary care team meetings to ensure quality outcomes.
The Program Manager provides subject matter expertise to align and implement healthcare services strategies across health plans. They act as a liaison between enterprise and market teams to facilitate communication, manage operational risks, and drive successful program execution.
The Director leads the health plan provider relations team, overseeing network development, provider education, and issue resolution. They collaborate with internal stakeholders to implement strategic network planning and ensure compliance with state and federal regulations.
The IRIS Consultant builds relationships with participants to help them navigate long-term care programs and achieve personal goals related to health, housing, and community integration. They are responsible for developing customized plans, managing budgets, and documenting all activities within the program's data system.
The manager leads the actuarial team in analyzing data to identify risks, establish premium rates, and provide liability estimates. They are responsible for mentoring staff, overseeing formal actuarial reporting, and designing studies related to medical care costs.
The processor facilitates coordination of benefits by validating medical and pharmacy coverage through provider portals and outbound calls. They also maintain internal databases and submit claim adjustments to ensure accurate payment and compliance with regulatory requirements.
Provides non-clinical administrative support to the care management team, including case assignment, data entry, and member scheduling. Facilitates communication between internal and external stakeholders to ensure effective delivery of member care services.
The specialist oversees and implements health plan quality improvement activities to ensure compliance with NCQA, federal, and state regulatory requirements. They are responsible for monitoring quality metrics, conducting medical record audits, and facilitating systemic quality of care investigations.
Leads and directs a multidisciplinary team of healthcare professionals in functions such as utilization management, behavioral health, and care transitions. Ensures integrated delivery of care, regulatory compliance, and the achievement of quality and cost-effective member outcomes.
The Senior Specialist performs chart reviews and audits to ensure accurate diagnosis and CPT coding while monitoring adherence to compliance programs. They also facilitate provider education on risk adjustment best practices and collaborate with cross-functional teams to resolve coding discrepancies.
The VP of Data & Analytics will lead enterprise-wide business intelligence and AI initiatives to improve operational efficiency and member outcomes. They will act as a strategic advisor to executive leadership, building scalable analytics solutions and fostering a data-driven culture across the organization.
The RN will provide oversight, guidance, and education to participants in the IRIS Self-Directed Personal Care program. Responsibilities include conducting assessments, developing person-centered care plans, and ensuring compliance with program regulations.
The RN will provide oversight, assessment, and care planning for participants in the IRIS Self-Directed Personal Care program. Responsibilities include conducting home visits, training care providers, and ensuring compliance with program documentation and regulations.
The Program Manager is responsible for planning and directing project schedules, budgets, and cross-functional teams to support new vendor implementations. They ensure governance standards are upheld while tracking performance metrics and managing program collateral.
The Care Manager coordinates integrated care for members with high-need potential by developing and monitoring comprehensive care plans. They also conduct in-person assessments, facilitate waiver enrollment, and collaborate with multidisciplinary teams to ensure quality and cost-effective outcomes.
The Senior Analyst provides support for advanced provider data management activities, including analyzing business processes and identifying areas for improvement. They also lead cross-functional projects, manage provider databases, and collaborate with stakeholders to translate business objectives into functional specifications.
The Care Manager coordinates long-term services and supports for members, including conducting comprehensive assessments and developing individualized care plans. They facilitate interdisciplinary team meetings and monitor member progress to ensure quality, cost-effective care delivery.
The Corporate Development Manager supports the execution of merger and acquisition transactions and advances the company's inorganic growth strategy. This role involves identifying and evaluating growth initiatives while coordinating due diligence and cross-functional deal activities.
The Pharmacy Services Director provides leadership for health plan pharmacy programs, ensuring quality, cost-effectiveness, and regulatory compliance. They act as a subject matter expert, overseeing utilization management and collaborating with internal and external stakeholders to optimize medication-related health outcomes.
Provide level I support center services to Molina members and providers by resolving inquiries via phone, chat, and email. Document interactions accurately while maintaining performance goals and collaborating with internal and external stakeholders.
The specialist supports the development, review, and maintenance of government contract documents and regulatory requirements for Medicaid, Medicare, and Marketplace programs. They coordinate regulatory deliverables, monitor compliance, and partner with internal departments to ensure contractual obligations are met.
The analyst is responsible for interpreting regulatory requirements and coordinating with stakeholders to support system solutions development. They also facilitate user acceptance testing and monitor policy updates to ensure organizational compliance.
The Care Manager provides care coordination and support for members with high-need potential by developing and monitoring comprehensive care plans. They facilitate interdisciplinary team meetings and conduct assessments to ensure members receive quality, cost-effective services.
The Care Manager provides support for LTSS-specific activities and coordinates integrated delivery of member care across the continuum. They are responsible for completing comprehensive member assessments, developing care plans, and facilitating interdisciplinary care team meetings.
Manages clinical validation and payment integrity review operations to ensure accurate, defensible, and timely claim outcomes. Collaborates with cross-functional stakeholders to resolve complex billing issues and improve workflow performance.
The Senior Representative serves as the primary point of contact for contracted providers, managing network adequacy, provider education, and issue resolution. They are responsible for conducting site visits, ensuring compliance with Molina policies, and fostering partnerships to improve member outcomes.
The Care Manager conducts comprehensive assessments and develops integrated care plans for Medicare members to ensure quality outcomes. They facilitate interdisciplinary care team meetings and perform ongoing monitoring of member progress through telephonic and face-to-face outreach.
Facilitate the research and resolution of member and provider appeals, grievances, and complaints in accordance with CMS standards. Ensure all responses are accurate, timely, and compliant with state and federal regulatory guidelines.
Provides non-clinical administrative support to the care management team, including case assignment, member screening, and data entry. Facilitates communication between internal and external stakeholders to ensure effective care management services.
The Eligibility Screener conducts face-to-face Adult Long-Term Care Functional Screens for IRIS program participants to determine eligibility. They also coordinate with consultants, agencies, and medical professionals to verify screening results and maintain accurate documentation.
The manager provides leadership for provider engagement strategies to drive quality and risk adjustment outcomes through consultative physician collaboration. They ensure assigned providers meet performance goals by developing action plans, managing practice environment challenges, and utilizing data-driven insights.
The manager will oversee quality performance improvement initiatives and manage data collection strategies to improve health outcomes. They will also ensure compliance with regulatory audit guidelines and collaborate with cross-functional teams to close quality care gaps.
The manager leads the Quality Systems team to execute quality initiatives, manage performance data, and ensure regulatory compliance. They collaborate with cross-functional stakeholders to develop data-driven strategies that improve program performance and address quality care gaps.
The Care Manager coordinates integrated delivery of care for members with high-need potential by developing and monitoring comprehensive care plans. They also conduct in-person assessments, facilitate waiver enrollment, and collaborate with multidisciplinary teams to ensure quality and cost-effective outcomes.
The Lead Analyst is responsible for interpreting regulatory and contractual requirements to document system configuration parameters for claims processing. They also coordinate with cross-functional teams to ensure compliant, timely claim payments and support system upgrades and defect resolution.
This role is responsible for ensuring compliance with Michigan Medicaid population health contract requirements and managing relationships with community-based organizations. The manager will design and implement population health programs while utilizing data analysis to drive business decisions and improve member health outcomes.
The Program Manager will lead all phases of the program lifecycle, including planning, execution, and monitoring, while ensuring alignment with business priorities. They will coordinate cross-functional stakeholders, manage program-level risks and dependencies, and report on key performance indicators.
The RN will provide oversight, assessment, and guidance to participants in the IRIS Self-Directed Personal Care program. Responsibilities include developing person-centered care plans, conducting home visits, and providing training to participants and care providers.
Provides non-clinical administrative support to the care management team, including case assignment, member screening, and data entry. Facilitates communication between internal and external stakeholders to ensure effective delivery of member care services.
The AVP of Infrastructure provides strategic leadership for enterprise infrastructure operations, technology platforms, and engineering across all business lines. They are responsible for shaping the long-term vision, ensuring scalable and secure systems, and managing high-performing teams to drive operational excellence.
The Manager leads cross-functional process optimization initiatives across Customer Experience, Sales, and Agent Operations to drive measurable improvements. They serve as a subject-matter expert for Salesforce and Genesys platforms, ensuring system integrity and alignment with business goals.
The manager is responsible for negotiating complex provider contracts, including value-based payment models, to ensure network adequacy and financial performance. They also lead strategic network development and provide mentorship to the contracting team.
The analyst will design and develop predictive analytics systems to support prospective and retrospective risk adjustment interventions. They will also conduct root-cause analysis, track risk scores, and generate automated reporting modules for various lines of business.
The clinician is responsible for conducting prior authorization reviews to ensure services are medically necessary and comply with clinical guidelines. They collaborate with multidisciplinary teams and medical directors to support quality member care and efficient utilization management.
The IRIS Consultant builds relationships with participants to help them navigate the Wisconsin IRIS program and achieve their long-term care goals. They are responsible for developing customized care plans, managing budgets, and documenting all activities within the program's data system.
The IRIS Consultant builds relationships with program participants to help them navigate long-term care options and achieve personal goals. They are responsible for developing customized care plans, managing budgets, and documenting all activities within the state data system.
Leads and directs a team responsible for medical economics analysis to identify risks, opportunities, and improve financial performance. Collaborates with health plans to track savings and drive trend performance reviews for Medicaid and behavioral health programs.
The nurse is responsible for reviewing medical documentation to ensure medical necessity and appropriate level of care using established clinical guidelines. They also facilitate the review of prospective, retrospective, and concurrent appeals for denied prior authorizations and claims.
The Senior Specialist is responsible for developing and implementing clinical quality member intervention initiatives across various lines of business. They monitor intervention activities, analyze outcomes, and collaborate with community-based organizations to improve health plan quality.
The Senior Tax Accountant provides senior-level support for tax compliance, planning, forecasting, and M&A evaluations. They are responsible for preparing federal and state corporate income tax returns and managing financial statement disclosures related to tax.
The manager will oversee quality performance improvement initiatives, manage data collection strategies, and ensure compliance with regulatory audit guidelines. They will collaborate with cross-functional teams to analyze quality data and identify opportunities to close care gaps.
The Lead Analyst designs and develops predictive analytics systems to support enterprise risk adjustment interventions and tracks their impact across various lines of business. They also conduct root-cause analysis, manage data warehouse reporting modules, and provide training to team members on analytical processes.
The Program Director provides subject matter expertise and leadership for quality improvement initiatives, including HEDIS performance measurement and NCQA accreditation. They are responsible for managing quality programs, monitoring key performance indicators, and collaborating cross-functionally to implement clinical interventions.
The Eligibility Screener conducts face-to-face Adult Long-Term Care Functional Screens to determine program eligibility for the Wisconsin IRIS program. They also verify screen results with consultants, agencies, and medical professionals while maintaining accurate documentation.
The Director leads the enterprise clinical data acquisition team, overseeing HEDIS operations, risk adjustment projects, and supplemental data source acquisition. They collaborate with health plan quality leads to drive performance reporting, manage vendor relationships, and implement strategic quality improvement initiatives.
The Eligibility Screener conducts face-to-face Adult Long-Term Care Functional Screens to determine program eligibility for IRIS participants. They also verify screening results with consultants, agencies, and medical professionals while maintaining accurate documentation.
The RN will provide oversight, guidance, and personal care assessments for individuals enrolled in the IRIS Self-Directed Personal Care program. Responsibilities include developing person-centered care plans, conducting home visits, and providing training to participants and care providers.
The IRIS Consultant builds relationships with participants to help them navigate the Medicaid long-term care program and achieve their personal goals. They are responsible for developing customized care plans, managing budgets, and documenting all activities within the program's data system.
The pharmacy technician will conduct outbound calls to members to support medication adherence and coordinate prescription refills. They will also collaborate with pharmacists and providers to resolve claim issues and support medication therapy management activities.
The Care Manager provides support for LTSS-specific activities and coordinates integrated care for members with high-need potential. They are responsible for conducting comprehensive assessments, developing care plans, and monitoring member progress toward desired health outcomes.
The Care Manager coordinates long-term services and supports for members, including conducting comprehensive assessments and developing individualized care plans. They facilitate interdisciplinary team meetings and monitor member progress to ensure quality, cost-effective care delivery.
The Care Manager coordinates long-term services and supports for members, developing and monitoring individualized care plans to ensure quality outcomes. They conduct comprehensive assessments, facilitate interdisciplinary team meetings, and provide ongoing support to address medical and psychosocial needs.
The Senior Analyst provides analytical support by extracting and synthesizing complex healthcare data to identify medical cost drivers and utilization trends. They collaborate with cross-functional teams to develop actionable insights, monitor performance, and recommend cost-containment strategies.
The Senior Analyst provides senior-level analytical support by extracting and synthesizing complex healthcare data to identify cost and utilization trends. They are responsible for developing actionable insights and affordability initiatives that enhance financial performance and support strategic decision-making.
Leads and directs the configuration team responsible for the delivery, execution, and maintenance of technical products supporting enterprise operations. Acts as the primary bridge between business stakeholders and technical delivery teams to ensure solutions align with business outcomes and regulatory requirements.
The Senior Specialist provides clinical support for quality improvement programs, audits, and federal/state compliance activities. They lead HEDIS medical record reviews and collaborate with cross-functional teams to ensure safe and efficient member care.
The Care Manager coordinates long-term services and supports for members, developing and monitoring individualized care plans to ensure quality outcomes. They conduct comprehensive assessments, facilitate interdisciplinary team meetings, and authorize appropriate waiver services while maintaining member health and welfare.
The role involves reviewing inpatient and outpatient clinical claims to ensure that coded diagnoses, procedures, and DRG assignments accurately reflect documented clinical conditions. The reviewer identifies billing inconsistencies and develops evidence-based rationales to support reimbursement determinations.
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.
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.
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.
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.
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.
Leads the reporting and analytics strategy to support business initiatives and management decision-making. Manages functional departments and ensures the quality and timely delivery of reports to provider networks and senior executives.
The analyst is responsible for interpreting regulatory requirements and coordinating with stakeholders to support system solutions. They also monitor policy updates, conduct root cause analysis, and ensure alignment across health plans and corporate functional areas.
