Molina Healthcare

(RN) Care Manager- Jail Transition Re-entry Program (REMOTE)

Molina Healthcare · Full Time · 2 days ago

Molina Healthcare

🌎 United States 💵 $26.41 - $59.21 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The Care Manager coordinates integrated care for members, conducting comprehensive assessments and developing personalized care plans. They facilitate interdisciplinary team meetings and monitor member progress to ensure quality, cost-effective outcomes.

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AVP, Data & Analytics - Clinical informatics/Risk and Quality - Remote

Molina Healthcare · Full Time · 2 days ago

Molina Healthcare

🌎 United States 💵 $161K - $315K per year ⭐ 10+ yrs exp 💼 Software Development

Direct comprehensive data and analytics initiatives to enhance payer strategy, operational excellence, and clinical outcomes across diverse populations. Oversee enterprise reporting, integrate AI/ML solutions, and foster cross-functional partnerships to drive organizational growth.

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AVP, Encounters (Remote)

Molina Healthcare · Full Time · 2 days ago

Molina Healthcare

🌎 United States 💵 $122K - $238K per year ⭐ 10+ yrs exp 💼 Others

The AVP of Encounters provides strategic leadership for the encounters function, ensuring accurate and timely submission of data to state and federal agencies. They manage cross-functional teams, oversee vendor performance, and implement process improvements to optimize operational efficiency and reduce healthcare costs.

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Care Review Clinician (RN) Remote

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

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

The Care Review Clinician assesses member service requests to ensure medical necessity, cost-effectiveness, and compliance with clinical guidelines and regulations. They collaborate with multidisciplinary teams and medical directors to facilitate appropriate care delivery and utilization management.

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Care Manager (BH) Remote (Salt Lake City, UT)

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States 💵 $26.41 - $51.49 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The Care Manager coordinates integrated member care by conducting behavioral health assessments and developing personalized care plans. They monitor member progress, facilitate interdisciplinary team meetings, and provide ongoing support to ensure quality and cost-effective outcomes.

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IRIS Self-Directed Personal Care (RN) (Milwaukee County, WI)

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States 💵 $26.41 - $51.49 per hour ⭐ 2-5 yrs exp 💼 Healthcare

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.

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Care Manager (RN) Remote (Dona Ana, NM)

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States 💵 $26.41 - $51.49 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The Care Manager provides support for care coordination activities and collaborates with a multidisciplinary team to manage integrated member care. They are responsible for conducting comprehensive assessments, developing care plans, and monitoring member progress toward desired health outcomes.

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Remote Medical Review Nurse (LVN/LPN)- PST schedule

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

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

The nurse is responsible for reviewing medical documentation to ensure medical necessity and appropriate level of care using clinical guidelines. They also validate medical records and claims to ensure accurate billing and reimbursement for providers.

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Care Review Clinician (RN) - reside in PST or MST

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

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

The clinician assesses member service requests to ensure medical necessity and compliance with clinical guidelines and insurance policies. They collaborate with multidisciplinary teams and medical directors to facilitate quality, cost-effective care across the continuum.

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Care Manager, LTSS (RN) Remote (Detroit, MI)

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The Care Manager coordinates long-term services and supports for high-need members by developing and monitoring comprehensive care plans. They facilitate interdisciplinary team meetings, conduct member assessments, and provide ongoing support to ensure quality and cost-effective care delivery.

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Care Manager, LTSS (RN) Remote (Warren, MI)

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States 💵 $26.41 - $51.49 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The Care Manager coordinates long-term services and supports for high-need members by developing care plans and conducting comprehensive assessments. They facilitate interdisciplinary team meetings and monitor member progress to ensure quality and cost-effective care delivery.

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Care Manager, LTSS

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

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 outcomes.

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Care Manager, LTSS

Molina Healthcare · Full Time · 3 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

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.

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Care Management Processor - STARS (MI based)

Molina Healthcare · Full Time · 4 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 team, including case assignment, member screening, and data entry. Facilitates communication between members and providers to ensure effective and cost-efficient care delivery.

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Pharmacy Technician, Prior Auth (Remote)

Molina Healthcare · Full Time · 4 days ago

Molina Healthcare

🌎 United States 💵 $12.19 - $26.42 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The technician will review and process prior authorization requests for non-formulary medications while ensuring compliance with pharmacy policies. They will also assist providers and members in resolving prescription claims and pharmacy service access issues.

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Analyst, Finance & Analytics - REMOTE

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

🌎 United States 💵 $83252 - $128K per year ⭐ 2-5 yrs exp 💼 Software Development

The analyst will perform financial analysis, data mining, and modeling to identify business trends and support informed decision-making. They will also collaborate with stakeholders to define requirements and develop standard reports or process improvements.

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Program Director - Home Health Coordinator Planning Office (Florida Health Plan) - Remote in Florida

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

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

The Program Director leads the Home Health Coordinator Planning Office, overseeing operational planning, financial management, and regulatory compliance for Florida CMS populations. This role acts as a central coordination point to ensure seamless service delivery, provider engagement, and the resolution of complex operational issues.

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AVP, Data Science & Analytics - Top Tech Distinguished Engineer - Remote

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

🌎 United States ⭐ 10+ yrs exp 💼 Software Development

Lead data science and analytics initiatives to drive strategic decision-making and operational efficiency across healthcare domains. Oversee the development of data models and provide actionable insights through comprehensive analysis to optimize revenue and healthcare outcomes.

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Director, Government Contracts (Medicaid / Florida Health Plan) - Remote in Florida

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

🌎 United States 💵 $96325.57 - $208K per year ⭐ 10+ yrs exp 💼 Healthcare

Leads the team responsible for the development, administration, and regulatory compliance of government contracts for Medicaid, Medicare, and Marketplace programs. Serves as the primary liaison with state healthcare agencies and oversees the implementation of new contractual standards.

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Manager, Actuarial Services - REMOTE

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Others

Leads a team providing subject matter expertise in Medicaid risk adjustment across multiple states. Responsibilities include analyzing data to identify risks, overseeing risk adjustment models, and providing technical guidance to actuarial staff.

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Specialist, Claims Recovery (Remote)

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

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

Supports claims recovery by researching overpayment accuracy and provider compliance based on federal regulations and billing guidelines. Collaborates with health plans and vendors to facilitate the recovery of outstanding overpayments and manages the claims backlog.

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Senior ServiceNow Engineer – AI Enablement & Platform Strategy - Remote

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

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

Drive the strategic evolution and AI adoption of the ServiceNow platform, focusing on automation and predictive intelligence. Manage the platform roadmap, optimize licensing costs, and ensure scalable, secure configurations across the enterprise.

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Care Review Clinician (RN) Remote (KY RN License or Compact)

Molina Healthcare · Full Time · 9 days ago

Molina Healthcare

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

The role involves reviewing clinical service requests to ensure medical necessity and compliance with state and federal regulations. The clinician collaborates with multidisciplinary teams and medical directors to optimize member outcomes and cost-effectiveness.

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Senior Project Manager, PMO - Managed Healthcare Payer Growth and Portfolio - Remote

Molina Healthcare · Full Time · 9 days ago

Molina Healthcare

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

The role focuses on process improvement, organizational change management, and managing complex projects within the managed healthcare payer growth portfolio. Key duties include estimating, scheduling, costing, and managing risks and issues across cross-functional teams.

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Remote Clinical Validation Reviewer (RN)

Molina Healthcare · Full Time · 9 days ago

Molina Healthcare

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

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.

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Specialist, IRIS Eligibility Screening

Molina Healthcare · Full Time · 10 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Responsible for completing Adult Long-Term Care Functional Screens (LTC-FS) for Wisconsin IRIS program participants to ensure Medicaid eligibility. This includes conducting face-to-face screenings, verifying results with medical providers, and maintaining detailed documentation.

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Care Manager, LTSS

Molina Healthcare · Full Time · 10 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Provides care management and coordination for members with high-need potential, specifically focusing on long-term services and supports (LTSS). Responsibilities include conducting comprehensive assessments, developing care plans, and facilitating waiver enrollment processes.

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Analyst, Pre-Pay Dispute Coding (Remote)

Molina Healthcare · Full Time · 10 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Investigate and resolve provider appeals by reviewing medical records and claims to ensure adherence to billing standards. Communicate determinations to providers and collaborate with internal departments to correct coding errors.

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Senior Specialist, Coding (Remote)

Molina Healthcare · Full Time · 10 days ago

Molina Healthcare

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

The role supports Payment Integrity Prepay operations by researching coding edit inquiries and validating coding rationale to ensure accuracy. It involves partnering with Health Plans and vendors to monitor savings trends and resolve coding-related escalations.

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Care Review Clinician (RN) Remote

Molina Healthcare · Full Time · 10 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Conduct medical necessity reviews for Medicare inpatient admissions and ongoing services using clinical guidelines and regulatory policies. Collaborate with providers and multidisciplinary teams to ensure cost-effective care delivery and regulatory compliance.

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Care Review Clinician (RN) Remote

Molina Healthcare · Full Time · 10 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The clinician assesses clinical service requests to ensure medical necessity and compliance with Medicare guidelines and insurance policies. They collaborate with multidisciplinary teams and medical directors to optimize member outcomes and cost-effectiveness.

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Senior Specialist, Coding (Remote)

Molina Healthcare · Full Time · 10 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The role focuses on researching coding edit inquiries and validating coding rationale to ensure payment integrity and accuracy. It involves partnering with health plans and vendors to monitor savings trends and resolve coding-related escalations.

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Analyst, Configuration Information Management - QNXT/SQL - Remote

Molina Healthcare · Full Time · 10 days ago

Molina Healthcare

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

Provides analyst support for configuration information management, focusing on the accurate implementation of claims databases and business rules. Responsibilities include maintaining benefit plans, provider contracts, and fee schedules while resolving claim and encounter issues.

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Associate Program Manager, Process & Performance Monitoring, Managed Care (Remote in FL Preferred)

Molina Healthcare · Full Time · 11 days ago

Molina Healthcare

🌎 United States 💵 $21.82 - $42.55 per hour ⭐ 2-5 yrs exp 💼 Product

Responsible for managing internal business projects and programs, focusing on process and performance monitoring for members receiving private duty nursing services. The role involves coordinating with cross-functional teams to ensure effective service delivery, compliance, and the creation of project artifacts.

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Manager, National Provider Services

Molina Healthcare · Full Time · 11 days ago

Molina Healthcare

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

Leads the national provider services team focusing on enterprise network management, adequacy, and provider education. Serves as the primary liaison between the business and contracted providers to ensure compliance and satisfaction.

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Care Review Clinician (RN) Remote (Must Reside In AZ)

Molina Healthcare · Full Time · 11 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The clinician is responsible for reviewing clinical service requests to ensure medical necessity and compliance with established guidelines and regulations. They collaborate with multidisciplinary teams to optimize member outcomes and manage cost-effective care delivery.

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Auditor, Healthcare Services (Remote in MI)

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

🌎 United States 💵 $26.41 - $51.49 per hour ⭐ 2-5 yrs exp 💼 Finance

Performs clinical audits across various functional areas to ensure compliance with regulatory requirements and quality standards. Reports outcomes to leadership and collaborates with training teams to address gaps in care and staff performance.

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

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

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

The clinician is responsible for verifying that medical services are necessary and align with clinical guidelines and insurance policies. They analyze service requests and collaborate with multidisciplinary teams to ensure cost-effective member care.

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Senior Representative, Health Plan Provider Relations - Remote Must reside in NE

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Provides senior-level support for health plan provider relations, focusing on network development, adequacy, and provider education. Serves as the primary point of contact for complex providers to ensure satisfaction and compliance with company policies.

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Pharmacy Technician, Prior Auth, Remote

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

🌎 United States 💵 $12.19 - $26.42 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Provides support for pharmacy technician activities by reviewing non-formulary and prior authorization requests against approved criteria. Facilitates approvals or denials and assists members and providers in resolving prescription claims and service access issues.

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Director, Value-Based Programs

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

🌎 United States ⭐ 10+ yrs exp 💼 Others

Leads the development and implementation of value-based strategies and reimbursement models for government lines of business. Manages a high-performance team to improve risk adjustment revenue accuracy, compliance, and completeness.

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National Quality Performance Manager (Remote)

Molina Healthcare · Full Time · 13 days ago

Molina Healthcare

🌎 United States 💵 $59810.6 - $129K per year ⭐ 2-5 yrs exp 💼 Others

Provides subject matter expertise for risk and quality performance solutions to improve health outcomes through data collection and analytics. Manages quality-related projects, ensures regulatory compliance for HEDIS audits, and collaborates with cross-functional teams to close care gaps.

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Health Plan Provider Relations Representative

Molina Healthcare · Full Time · 13 days ago

Molina Healthcare

🌎 United States 💵 $18.85 - $38.69 per hour ⭐ 2-5 yrs exp 💼 Healthcare

Serves as the primary point of contact for contracted providers to ensure satisfaction, compliance with policies, and adoption of electronic tools. Conducts regular site visits and delivers training to improve coordination between the health plan and the provider community.

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Analyst, Compliance - (Remote) Must have experience with Medicare Advantage and CMS regulatory requirements.(Remote) Must have experience with Medicare Advantage and CMS regulatory requirements.

Molina Healthcare · Full Time · 13 days ago

Molina Healthcare

🌎 United States 💵 $52426 - $102K per year ⭐ 2-5 yrs exp 💼 Legal

Provides analyst support to ensure the organization adheres to regulatory requirements, industry standards, and internal policies. Responsibilities include managing compliance incidents, facilitating required reporting, and interpreting federal and state rules.

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Specialist, Appeals & Grievances Remote

Molina Healthcare · Full Time · 16 days ago

Molina Healthcare

🌎 United States 💵 $18.35 - $31.97 per hour ⭐ 2-5 yrs exp 💼 Others

Responsible for researching and resolving member and provider appeals, disputes, and grievances in compliance with CMS standards. This includes reviewing medical records, analyzing claims payment errors, and composing formal regulatory responses.

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Remote Care Manager (Behavioral health licensee- based in SC)

Molina Healthcare · Full Time · 16 days ago

Molina Healthcare

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

Provides comprehensive behavioral health assessments and develops integrated care plans for members. Coordinates with multidisciplinary teams to ensure quality, cost-effective care and monitors member progress toward health outcomes.

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(RN) Remote Care Manager - SC based

Molina Healthcare · Full Time · 16 days ago

Molina Healthcare

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

Provides care management and coordination by conducting comprehensive assessments and developing integrated care plans for members. Collaborates with multidisciplinary teams to monitor progress and ensure quality, cost-effective healthcare delivery.

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Director, Data Analytics (Customer Experience / Member Growth & Retention) - REMOTE

Molina Healthcare · Full Time · 16 days ago

Molina Healthcare

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

The Director of Data Analytics leads the creation of executive reports and analytical insights to support member growth, retention, and customer experience. This role manages a team of analysts to monitor operational, clinical, and financial results across various interdepartmental functions.

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Specialist, Health Plan Provider Engagement (Remote in MS)

Molina Healthcare · Full Time · 16 days ago

Molina Healthcare

🌎 United States 💵 $40851.44 - $88511.46 per year ⭐ 2-5 yrs exp 💼 Healthcare

Implement health plan provider engagement strategies to drive quality and risk adjustment outcomes for Tier 2 and Tier 3 providers. This involves coaching providers, analyzing data to improve performance, and addressing practice barriers to enhance health outcomes.

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Manager, Health Plan Marketing Communications, MCO (Remote, must reside in or near Illinois)

Molina Healthcare · Full Time · 17 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Marketing

Leads the team responsible for health plan marketing and communications, ensuring all materials align with brand standards and regulatory requirements. Manages the development, distribution, and approval process for member and provider communications across various media platforms.

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Pharmacist, Utilization Management/Prior Auth (Remote)

Molina Healthcare · Full Time · 17 days ago

Molina Healthcare

🌎 United States 💵 $80412 - $156K per year ⭐ 2-5 yrs exp 💼 Healthcare

Provides subject matter expertise for pharmacy formulary activities and ensures compliance with coverage determination and appeals processes. Collaborates with medical directors and PBMs to optimize medication outcomes and manage cost-control initiatives.

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Auditor, Risk Adjustment (Remote)

Molina Healthcare · Full Time · 17 days ago

Molina Healthcare

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

Provides audit support for risk adjustment activities by developing controls to minimize financial risks and losses. Manages data validation, monitors RAPS and EDPS transmissions, and ensures compliance with CMS regulations.

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Supervisor, Support Center Operations (Remote, CST Preferred)

Molina Healthcare · Full Time · 17 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Support

Leads and supervises the support center team to ensure excellence in customer service for Molina members and providers. Manages escalations, ensures regulatory compliance, and drives continuous quality improvement initiatives.

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Remote Pharmacist, Quality Withhold Clinical/Medication Therapy Management

Molina Healthcare · Full Time · 18 days ago

Molina Healthcare

🌎 United States 💵 $72370.82 - $156K per year ⭐ 2-5 yrs exp 💼 Healthcare

The role involves reviewing quality measures and providing subject matter expertise for Medication Therapy Management (MTM) to optimize member health outcomes. Key duties include conducting comprehensive medication reviews, analyzing patient safety issues, and implementing drug utilization strategies.

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Representative, Support Center (Bilingual English/Spanish)

Molina Healthcare · Full Time · 18 days ago

Molina Healthcare

🌎 United States ⭐ 0-2 yrs exp 💼 Support

Provide level I customer service support to members and providers via phone, chat, and email. Resolve inquiries regarding eligibility, benefits, and claims while documenting all interactions accurately.

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Director, Data & Analytics - FL Health Plan (REMOTE)

Molina Healthcare · Full Time · 18 days ago

Molina Healthcare

🌎 United States ⭐ 10+ yrs exp 💼 Software Development

Leads the design and delivery of data-driven insights and regulatory reporting to support strategic and operational decision-making for the Florida Health Plan. Partners with executive leadership to translate complex healthcare data into actionable metrics for cost containment and compliance.

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Engineer, EIS - Endpoint Security - Remote

Molina Healthcare · Full Time · 18 days ago

Molina Healthcare

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

The role involves building company-specific systems and providing technical expertise across infrastructure and development disciplines. Key duties include troubleshooting, incident resolution, and contributing to solution architecture and project deliverables.

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Senior Analyst, Data & Analytics - SQL/Payment Integrity - Remote

Molina Healthcare · Full Time · 19 days ago

Molina Healthcare

🌎 United States 💵 $59810 - $129K per year ⭐ 2-5 yrs exp 💼 Software Development

The role involves analyzing complex healthcare datasets to generate strategic insights and designing scalable reporting solutions using SQL and SSRS. The analyst will partner with stakeholders to translate business needs into actionable data models and drive process improvements.

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Pharmacy Tech, Prior Auth CPhT or PTCB (Remote)

Molina Healthcare · Full Time · 20 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Review prior authorization requests for medications to determine medical necessity and assist with pharmacy claims. Support pharmacy strategy to optimize healthcare outcomes and coordinate with providers and members to resolve prescription issues.

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Care Review Clinician (RN) Remote

Molina Healthcare · Full Time · 20 days ago

Molina Healthcare

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

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

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Manager, Health Plan Provider Engagement (Remote in MS)

Molina Healthcare · Full Time · 20 days 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 Provider Engagement (Remote in MS)

Molina Healthcare · Full Time · 20 days 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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Senior Specialist, Health Plan Member & Community Interventions (Remote in MS)

Molina Healthcare · Full Time · 20 days 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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Analyst, Workforce Scheduling - Remote

Molina Healthcare · Full Time · 20 days 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 · 20 days 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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Lead Analyst, Healthcare Analytics (Data Stewardship & Enterprise Reporting) – Remote

Molina Healthcare · Full Time · 23 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 · 23 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 · 23 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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Care Review Clinician (RN) Remote

Molina Healthcare · Full Time · 23 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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Senior Engineer, EIS - SASE & Data Security - Remote

Molina Healthcare · Full Time · 23 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 · 24 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 · 24 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 · 24 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 · 24 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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Health Plan Provider Contracts Manager - Complex

Molina Healthcare · Full Time · 24 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 · 25 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 · 25 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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Care Management Processor (Central Time Zone Hours) - REMOTE

Molina Healthcare · Full Time · 25 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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Care Review Clinician (RN) - (IL Nursing license)

Molina Healthcare · Full Time · 25 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 · 25 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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Senior Engineer, Big Data - Payment Integrity/Databricks - Remote

Molina Healthcare · Full Time · 25 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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