This role provides senior-level analysis of complex healthcare data to generate actionable insights for strategic decision-making. The analyst will design and maintain reporting solutions, dashboards, and data processes while partnering with stakeholders to drive business performance.
The analyst will design, develop, and maintain data reports and dashboards to support healthcare utilization and operational performance. They will also collaborate with cross-functional teams to translate business needs into actionable insights and ensure data integrity across various datasets.
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 Supervisor leads a team responsible for claims activities, including payment administration, record maintenance, and benefit interpretation. They are also responsible for monitoring workflow, ensuring timely settlements, and developing staff performance.
The 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 outcomes and process authorizations within required timelines.
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 representative will handle inbound and outbound pharmacy calls from members, providers, and pharmacies to assist with prior authorizations and benefit inquiries. They will also support pharmacists with medication reviews and ensure accurate documentation within the call tracking system.
The Lead Clinical Validation Reviewer provides support for clinical validation operations by coordinating workflows, ensuring review consistency, and assisting with training and process improvements. They perform advanced clinical reviews of claims to verify that coded diagnoses, procedures, and billed charges accurately reflect the patient's documented clinical condition and reimbursement requirements.
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.
Provide level III support center service to members and providers across multiple communication channels including phone, chat, and email. Resolve complex issues related to eligibility, claims, and appeals while maintaining accurate documentation and supporting quality improvement initiatives.
The Senior Business Analyst will analyze enrollment data, fix operational issues, and build reporting dashboards to ensure compliance with CMS and state regulations. They will also coordinate cross-functionally to document business requirements and support system solutions for coverage and reimbursement functions.
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.
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.
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.
The Coordination of Benefits Processor provides administrative and data entry support to validate insurance leads and update claims systems. They also coordinate with CMS and other carriers to manage premium restoration and insurance records.
The Director leads the strategic development and lifecycle management of the organization's post-pay payment integrity portfolio. They serve as a key liaison between health plans, data science, and executive leadership to ensure operational and financial objectives are met.
The Director leads and directs government advocacy activities, monitoring legislative and regulatory initiatives to influence outcomes that benefit the business. They represent the company before federal and state agencies while managing relationships with key congressional and state delegates.
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 Care Manager coordinates integrated care for high-need members by developing and monitoring personalized care plans and facilitating interdisciplinary team meetings. They conduct comprehensive assessments, authorize waiver services, and provide ongoing support to ensure member health and welfare.
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 Program Director provides subject matter expertise and leadership for quality improvement initiatives, including HEDIS performance measurement and NCQA accreditation. They are responsible for managing clinical interventions, monitoring key performance indicators, and collaborating cross-functionally to ensure compliance and program effectiveness.
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 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 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 Program Director provides subject matter expertise for risk and quality solutions while collaborating with health plan leaders to optimize performance. They are responsible for ensuring action plans are accurate and escalating barriers to implementation to leadership.
The auditor facilitates call monitoring and assessment for support center representatives to ensure compliance and quality standards. They also collaborate with leadership to generate performance reports and develop procedural manuals for process improvement.
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.
The analyst reviews medical coding-related claim denials by examining medical records and claim history to ensure billing accuracy. They also communicate determinations to providers and collaborate with internal departments to resolve coding inconsistencies.
The Principal Architect provides deep subject matter expertise to lead enterprise architecture activities and create long-term strategic roadmaps for IT systems. They facilitate the implementation of technology standards, lead cross-functional architecture programs, and ensure IT strategies align with business goals.
The Director leads the execution of enterprise initiatives to improve HEDIS measures and Medicare Star Ratings. This role coordinates cross-functional workstreams across markets and shared services to drive operational performance and data integrity.
The Senior Project Manager is responsible for supporting the project lifecycle, including planning, execution, and monitoring of business and technology projects. They lead cross-functional teams, manage project scope and budgets, and ensure alignment with organizational priorities.
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 care planning for individuals enrolled in the IRIS Self-Directed Personal Care program. Responsibilities include conducting home visits, training participants and providers, and ensuring compliance with state documentation requirements.
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 Lead Engineer will design and implement enterprise-scale big data solutions on Azure while mentoring team members on AI-first development practices. They will partner with business leaders to deliver data-driven insights and analytical models to support Medicare/Medicaid operations.
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 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 member outcomes.
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 is responsible for the intake and interpretation of regulatory requirements to support system solutions and maintenance. They coordinate with stakeholders to ensure requirement alignment and manage documentation for coverage and reimbursement changes.
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 manager leads and oversees payment integrity activities, including recovery operations, performance management, and the establishment of operational standards. They are responsible for hiring and developing staff, monitoring quality assurance programs, and collaborating with internal departments to resolve process issues.
The Senior Representative manages provider relations by serving as the primary point of contact for complex community providers to ensure network adequacy and policy compliance. They are responsible for conducting site visits, facilitating provider education, and resolving complex issues to improve coordination between the health plan and contracted providers.
The manager provides subject matter expertise to lead quality performance improvement initiatives and manages data collection, analytics, and reporting. They also oversee quality data ingestion and ensure compliance with regulatory audit guidelines to maximize HEDIS success.
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 Transition of Care Coach facilitates the discharge process for hospitalized members to ensure a smooth transition to other settings and reduce readmissions. They collaborate with hospital staff and providers to coordinate care, conduct assessments, and educate members on their health needs.
The manager provides leadership for provider relations activities, including network development, provider education, and ensuring compliance with health plan policies. They serve as the primary point of contact for providers, resolving complex issues and conducting regular site visits to maintain network adequacy.
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 analyst provides technical support and design for clinical information systems to improve workflows and operational processes. They participate in the planning, implementation, and maintenance of electronic medical record (EMR) applications.
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 Senior Program Manager leads and executes Medicare Stars quality improvement initiatives by collaborating with cross-functional teams to meet performance goals. They are responsible for managing program budgets, monitoring key performance indicators, and providing subject matter expertise to drive organizational change.
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 Program Director provides subject matter expertise for risk and quality solutions while collaborating with health plan leaders to implement best practices. They are responsible for overseeing action plans, escalating implementation barriers, and driving business strategies to meet performance goals.
The investigator is responsible for preventing, detecting, and investigating health care fraud, waste, and abuse through data analysis and medical record reviews. They also coordinate with internal departments and regulatory agencies to prepare referrals and ensure compliance with contractual requirements.
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 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 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 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 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 Pharmacy CSR handles inbound and outbound calls from members and providers regarding pharmacy benefits, copays, and prior authorizations. They also support pharmacists with medication reviews and ensure accurate documentation within the call tracking system.
The pharmacy technician will review and process non-formulary and prior authorization requests while ensuring compliance with pharmacy policies. They will also assist providers and members with prescription claims and pharmacy service access issues.
The Senior Analyst supports the out-of-network provider liability model by developing analytics, reporting, and market intelligence to inform negotiation strategies and dispute outcomes. They are responsible for integrating complex datasets, building dashboards, and translating financial data into actionable insights for leadership.
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 Accountant provides senior-level accounting support including month-end close, account reconciliations, and financial statement preparation. They ensure compliance with GAAP and Statutory Accounting Principles while collaborating with interdepartmental partners to validate financial reporting accuracy.
The role involves designing and deploying advanced machine learning models and AI solutions to derive insights from large datasets. Responsibilities also include implementing agentic workflows and retrieval-augmented generation patterns to enhance operational efficiency and model performance.
The clinician is responsible for verifying the medical necessity of behavioral health services and ensuring compliance with clinical guidelines and insurance policies. They collaborate with multidisciplinary teams and providers to manage treatment plans and support member outcomes.
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.
The Care Manager supports Medicaid members by conducting assessments, developing care plans, and facilitating interdisciplinary team meetings. They perform both telephonic outreach and in-person home visits to monitor member progress and ensure quality, cost-effective care.
The analyst is responsible for the intake and interpretation of regulatory requirements to support system solutions and maintenance. They also coordinate with stakeholders to ensure alignment, manage requirement documentation, and apply automation tools to improve operational efficiency.
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 Care Manager coordinates integrated delivery of care for high-need members by developing and monitoring personalized care plans. They facilitate interdisciplinary team meetings and conduct comprehensive assessments to ensure quality and cost-effective service delivery.
Leads and manages a team responsible for pharmacy operations and Pharmacy Benefit Management (PBM) activities, including oversight of delegated services and product implementation. Collaborates with cross-functional partners to optimize medication-related health outcomes and ensures compliance with state and federal regulations.
The investigator will re-evaluate medical claims and records to identify and resolve instances of fraud, waste, and abuse. They will manage caseloads, ensure regulatory compliance, and prepare clinical summaries to support potential law enforcement referrals or payment recoveries.
The AVP will lead the strategy, development, and negotiation of value-based contracts across the enterprise to lower healthcare costs. They are responsible for managing complex partnerships, aligning cross-functional stakeholders, and overseeing a high-performance team to achieve business objectives.
The Senior Proposal Writer is responsible for developing, writing, and revising compelling, compliant, and technically accurate content for government-sponsored health care RFPs. They collaborate with subject matter experts and stakeholders to ensure proposals effectively communicate business value and meet all submission requirements.
The Director of Member Experience develops and implements enterprise-wide strategies to achieve Medicaid membership retention goals and improve member satisfaction. This role drives process improvements across pharmacy, network, and provider relations while collaborating with leadership to ensure strategic alignment.
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 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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Leads the health plan provider network contracting activities, focusing on strategy, adequacy, and financial performance. Responsible for negotiating complex contracts, including value-based payment models and capitated payments for various healthcare entities.
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.
