Molina Healthcare

Supervisor, Healthcare Services

Molina Healthcare · Full Time · 11 hours ago

Molina Healthcare

🌎 United States 💵 $66456 - $129K per year ⭐ 5-10 yrs exp 💼 Healthcare

Leads and supervises a multidisciplinary team of healthcare professionals to ensure integrated delivery and coordination of care. Oversees day-to-day operations, staff training, and performance monitoring to achieve quality and cost-effective member outcomes.

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Pharmacy Technician Prior Auth, Remote

Molina Healthcare · Full Time · 14 hours ago

Molina Healthcare

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

Review and process non-formulary and prior authorization requests against approved pharmacy plan criteria. Provide support for pharmacy technician activities and resolve member prescription claims and service access issues.

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

Molina Healthcare · Full Time · 5 days ago

Molina Healthcare

🌎 United States ⭐ 10+ yrs exp 💼 Software Development

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

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Specialist, Member Engagement - Remote must be in Ohio

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Acts as a subject matter expert and advocate for Molina members regarding extra benefits and covered services to increase retention and satisfaction. Oversees the tracking and reporting of value-added benefits for Medicaid and MyCare Ohio while collaborating with internal and external stakeholders.

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Manager, Medical Economics (Trend Analytics, Cost of Care) - REMOTE

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

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

Leads the medical economics team in analyzing cost trends and identifying financial risks and opportunities to improve performance. Collaborates with health plans to develop tracking tools and provides data-driven insights to guide clinical strategy and decision-making.

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(RN) Critical Incidents Specialist (New Mexico Based, Remote)

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

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

Provides support for critical incident management by coordinating integrated care delivery and monitoring referrals for members. Collaborates with multidisciplinary teams to assess risks and presents data to departmental leadership.

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Business Analyst

Molina Healthcare · Full Time · 6 days ago

Molina Healthcare

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

Responsible for the intake and interpretation of regulatory and functional requirements to support systems solutions for coverage and reimbursement. This role involves coordinating with stakeholders and governance committees to ensure alignment with health plan requirements.

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Business Analyst (Remote)

Molina Healthcare · Full Time · 7 days ago

Molina Healthcare

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

Responsible for the intake and interpretation of regulatory and functional requirements related to coverage, reimbursement, and processing. The role involves coordinating with stakeholders to ensure system solutions align with regulatory baselines and health plan requirements.

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Senior Solution Architect - Genesys CX Cloud/API intergration/Voice AI - Remote

Molina Healthcare · Full Time · 7 days ago

Molina Healthcare

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

Leads the solution design and architectural blueprinting for enterprise applications, mapping business requirements to technical specifications. Collaborates with cross-functional IT teams to integrate systems and ensure alignment with security and enterprise architecture standards.

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Adjudicator, Provider Claims - Remote Ohio On the phone-closing shift

Molina Healthcare · Full Time · 7 days ago

Molina Healthcare

🌎 United States 💵 $14.76 - $31.97 per hour ⭐ 2-5 yrs exp 💼 Legal

Responsible for adjudicating provider claims and resolving inquiries through research and collaboration with internal teams. The role involves handling incoming provider calls and ensuring claims are processed accurately and timely.

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Director, Finance & Analytics - REMOTE

Molina Healthcare · Full Time · 7 days ago

Molina Healthcare

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

Leads a team responsible for financial analysis, operational performance, and strategic partnerships to support data-driven decision-making. Oversees financial reporting, budget variance analysis, and collaboration with cross-functional teams to improve profitability.

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Care Review Processor - Remote

Molina Healthcare · Full Time · 8 days ago

Molina Healthcare

🌎 United States ⭐ 0-2 yrs exp 💼 Others

Provides non-clinical administrative support to the utilization management team, including data entry for authorization requests and provider inquiries. Coordinates with physician offices to obtain missing information and ensures quality and compliance in all clinical correspondence.

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Manager, Applications - ADF/ETL/AI - Remote

Molina Healthcare · Full Time · 8 days ago

Molina Healthcare

🌎 United States 💵 $87568.7 - $189K per year ⭐ 5-10 yrs exp 💼 Software Development

Lead a team of 10 direct reports responsible for ETL development, reporting support, and AI adoption across healthcare claims workstreams. Oversee the migration from SSIS to Azure Data Factory and ensure operational rigor in delivery processes.

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Senior Analyst, Medical Economics (Cost of Care & Trend Analytics) - REMOTE

Molina Healthcare · Full Time · 10 days ago

Molina Healthcare

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

Provides senior-level analytical support to identify cost-saving opportunities and analyze medical cost trends. Develops financial models and reports to support executive decision-making and improve health plan performance.

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Senior Business Analyst

Molina Healthcare · Full Time · 10 days ago

Molina Healthcare

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

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

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Analyst, Data & Analytics - Value Base Programs/Excel - Remote

Molina Healthcare · Full Time · 10 days ago

Molina Healthcare

🌎 United States 💵 $52176 - $107K per year ⭐ 2-5 yrs exp 💼 Software Development

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

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Care Review Clinician (RN) Remote (Must reside in Mississippi)

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 manage prior authorizations and promote cost-effective member care.

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Medicare Strategy and Operations Manager

Molina Healthcare · Full Time · 11 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Others

Develops and maintains state and product-specific Medicare strategies through data analysis and market research. Leads high-priority operational improvement initiatives and coordinates cross-functional alignment across the organization.

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Director, Delegation Oversight (California Utilization Management) - REMOTE

Molina Healthcare · Full Time · 11 days ago

Molina Healthcare

🌎 United States 💵 $79607.91 - $172K per year ⭐ 10+ yrs exp 💼 Others

Leads the team responsible for multi-state delegation oversight to ensure compliance with state, federal, and NCQA requirements. Manages relationships and performance of delegated entities through audits, corrective action plans, and strategic vendor management.

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Senior Program Manager (Remote)

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

🌎 United States 💵 $73102 - $142K per year ⭐ 5-10 yrs exp 💼 Product

Responsible for leading internal business projects and cross-functional teams to deliver products from design to completion. This includes managing CMS/HPMS submissions, overseeing project budgets, and collaborating with operational leaders for process improvements.

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Analyst, Compliance - Remote must have Medicare Advantage exp

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

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

Provides analyst support to ensure organizational adherence to regulatory requirements, industry standards, and internal policies. Manages compliance incidents, KPI reporting, and coordinates with state and federal regulators.

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Health Educator (Remote in Florida)

Molina Healthcare · Full Time · 12 days ago

Molina Healthcare

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

The Health Educator develops and maintains health education and disease management programs for Health Plan members. This includes researching materials, conducting data collection, and engaging members through direct calls to promote health and coordinate care.

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Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska

Molina Healthcare · Full Time · 13 days ago

Molina Healthcare

🌎 United States 💵 $27.59 - $56.63 per hour ⭐ 2-5 yrs exp 💼 Finance

Performs clinical audits across care management and behavioral health teams to ensure compliance with NCQA, CMS, and state guidelines. Reports monthly outcomes to leadership and assists in developing training materials to resolve audit findings.

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Analyst, Business

Molina Healthcare · Full Time · 13 days ago

Molina Healthcare

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

This role translates regulatory and business requirements into actionable edit configurations within pre-pay platforms. It involves owning the full lifecycle of edit development, from requirements intake and validation to deployment and maintenance.

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Principal Strategist, Value-Based Network Contracting

Molina Healthcare · Full Time · 13 days ago

Molina Healthcare

🌎 United States 💵 $79607.91 - $172K per year ⭐ 10+ yrs exp 💼 Teaching

Develops and leads network contracting strategies for Medicaid, Medicare, and Marketplace lines of business to optimize unit costs and enable growth. Manages key provider relationships and collaborates with internal stakeholders to design value-based care models and reimbursement strategies.

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Ombudsman (Medicaid / Florida Health Plan) - REMOTE

Molina Healthcare · Full Time · 13 days ago

Molina Healthcare

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

Responsible for investigating and resolving member grievances and advocating for member rights within the Medicaid health plan. The role involves identifying systemic challenges, documenting interactions, and collaborating with stakeholders to improve the member experience.

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Director, Health Plan Provider Contracts

Molina Healthcare · Full Time · 13 days ago

Molina Healthcare

🌎 United States ⭐ 10+ yrs exp 💼 Healthcare

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.

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Senior Analyst, Data & Analytics (Remote)

Molina Healthcare · Full Time · 13 days ago

Molina Healthcare

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

Provides senior-level analysis of complex healthcare and financial data to generate strategic insights and operational decision-making support. Designs and maintains scalable reporting solutions, dashboards, and data processes while partnering with stakeholders to define requirements.

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Senior Specialist, Health Plan Provider Engagement (Remote)

Molina Healthcare · Full Time · 14 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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Specialist, Health Plan Provider Engagement (Remote)

Molina Healthcare · Full Time · 14 days ago

Molina Healthcare

🌎 United States 💵 $45390 - $88511.46 per year ⭐ 2-5 yrs exp 💼 Healthcare

Supports health plan provider engagement by driving value-based care strategies, risk adjustment, and quality improvement activities. Collaborates with tier II and III providers through coaching and action plans to improve health outcomes and program performance.

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Investigator, Special Investigative Unit (Remote)

Molina Healthcare · Full Time · 14 days ago

Molina Healthcare

🌎 United States 💵 $22.91 - $44.68 per hour ⭐ 2-5 yrs exp 💼 Others

Provides investigative support to detect and prevent healthcare fraud, waste, and abuse (FWA) through data analysis and medical record reviews. Responsible for conducting end-to-end investigations, interviewing witnesses, and preparing referrals for law enforcement and regulatory agencies.

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Manager, Configuration - Product Owner/Custom Solutions - Remote

Molina Healthcare · Full Time · 15 days ago

Molina Healthcare

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

Leads the configuration team responsible for implementing and maintaining critical claims database information and ensuring adherence to health plan requirements. Acts as a primary liaison for stakeholders and manages audit submissions and operational compliance.

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Sr Analyst, Medical Economics – Remote (SQL, PMPM Analysis & Cost Trend Strategy)

Molina Healthcare · Full Time · 17 days ago

Molina Healthcare

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

Provides senior-level analysis of medical economics to identify cost trends, risks, and opportunities for financial improvement. Collaborates with clinical and network teams to develop predictive models and track key performance indicators for medical interventions.

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Supervisor, Healthcare Services (Remote in FL - Weekends)

Molina Healthcare · Full Time · 18 days ago

Molina Healthcare

🌎 United States 💵 $66456 - $129K per year ⭐ 5-10 yrs exp 💼 Healthcare

Leads and supervises a multidisciplinary team of healthcare professionals across functions like care and utilization management. Ensures members achieve desired outcomes through integrated care delivery and contributes to quality, cost-effective care strategies.

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Sr. Specialist, National Marketing & Communications (Care Connections) - REMOTE

Molina Healthcare · Full Time · 18 days ago

Molina Healthcare

🌎 United States 💵 $54373 - $117K per year ⭐ 2-5 yrs exp 💼 Marketing

Provides senior-level support for marketing and communications operations, focusing on workflow development and campaign execution. Ensures alignment between marketing strategy and operational goals to support member engagement and regulatory compliance.

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Associate Specialist, Communications (Care Connections) - REMOTE

Molina Healthcare · Full Time · 18 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Marketing

Develop results-oriented communications campaigns and create various materials including newsletters, intranet articles, and press releases. Manage small projects, editorial calendars, and employee engagement communications.

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Senior Financial Analyst – Regulatory Reporting & Healthcare Finance (Remote)

Molina Healthcare · Full Time · 18 days ago

Molina Healthcare

🌎 United States 💵 $54373.27 - $117K per year ⭐ 2-5 yrs exp 💼 Finance

Provides senior-level financial analysis, forecasting, and modeling to support business decisions for the Kentucky Health Plan. Manages regulatory reporting, pharmacy expense trends, and provider escrow accounting.

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Analyst, Finance & Analytics (Advanced SQL / Large-Scale Data) - REMOTE

Molina Healthcare · Full Time · 18 days ago

Molina Healthcare

🌎 United States 💵 $49430.25 - $107K per year ⭐ 0-2 yrs exp 💼 Software Development

The role involves extracting and analyzing large data sets to identify trends and provide financial insights for business decision-making. It requires collaborating across departments to develop standard reports and improve existing processes.

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RN- Care Review Clinician- Utilization Review (Remote- CA License Req)

Molina Healthcare · Full Time · 19 days ago

Molina Healthcare

🌎 United States 💵 $30.37 - $59.21 per hour ⭐ 2-5 yrs exp 💼 Healthcare

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

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Program Manager (Medicare Programs/Portfolio Mgmt) - REMOTE

Molina Healthcare · Full Time · 19 days ago

Molina Healthcare

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

Provides program management support for Medicare segments, focusing on governance frameworks, capability delivery, and internal process ownership. Acts as a primary interface between the Medicare Data & Analytics Team and stakeholders to oversee request intake and execution.

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(RN) Care Review Clinician - Weekend Role (REMOTE)

Molina Healthcare · Full Time · 19 days ago

Molina Healthcare

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

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

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Senior Tax Accountant (Remote)

Molina Healthcare · Full Time · 20 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Finance

Provides senior-level support for tax compliance, planning, and forecasting, including SEC and statutory reporting disclosures. Responsible for preparing federal, state, and local corporate income tax returns and managing tax provisions under GAAP.

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Remote -Pharmacy Technician, Clinical/Medication Therapy Mgmt

Molina Healthcare · Full Time · 21 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Provides support for Medication Therapy Management (MTM) activities to optimize medication-related health outcomes and cost-effective care. Collaborates with pharmacists and performs outreach to members and providers to resolve prescription claim and access issues.

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Director, Provider Network Management & Operations

Molina Healthcare · Full Time · 21 days ago

Molina Healthcare

🌎 United States ⭐ 10+ yrs exp 💼 Others

Leads the team responsible for provider network operations, contracting activities, and the development of reimbursement strategies. Negotiates complex contracts including value-based and capitated payments to ensure network adequacy and financial performance.

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Program Director, PMO - Medicaid - Remote

Molina Healthcare · Full Time · 21 days ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Product

The role focuses on process improvement, organizational change management, and managing complex enterprise-wide projects. Responsibilities include estimating, scheduling, costing, and developing solutions for complex problems across multiple projects.

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Analyst, Claims Research - Remote

Molina Healthcare · Full Time · 21 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Legal

Provides analytical support for claims research to ensure regulatory compliance and identify root causes of processing errors. Manages complex claims projects and collaborates with internal teams to implement operational fixes and improve efficiency.

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Part Time Medical Director ( OBGYN /Based in MS)

Molina Healthcare · Full Time · 22 days ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Provides medical oversight to ensure the appropriateness and medical necessity of services provided to members. Leads utilization management practices and ensures compliance with NCQA, URAC, and other regulatory requirements.

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National Value-Based Contracting Director

Molina Healthcare · Full Time · 22 days ago

Molina Healthcare

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

Lead national contracting activities and develop provider network strategies to ensure adequacy and financial performance. Negotiate complex agreements with integrated delivery systems, hospitals, and physician groups while maintaining reimbursement standards.

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Supervisor, Support Center Operations (Must reside in Florida, Remote)

Molina Healthcare · Full Time · 24 days ago

Molina Healthcare

🌎 United States 💵 $45390 - $84086 per year ⭐ 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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Program Manager-Medicaid Nebraska (Remote)

Molina Healthcare · Full Time · 25 days ago

Molina Healthcare

🌎 United States 💵 $63133 - $129K per year ⭐ 2-5 yrs exp 💼 Product

Provides program management support including policy documentation, budget management, and governance framework coordination. Responsible for creating business requirements, tracking performance metrics, and ensuring the adoption of program best practices.

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VP, Clinical Operations (Medicare Duals) - REMOTE

Molina Healthcare · Full Time · 25 days ago

Molina Healthcare

🌎 United States ⭐ 10+ yrs exp 💼 Healthcare

Provides executive leadership and strategy to optimize clinical operations and healthcare services across the enterprise. Ensures compliance with regulatory standards while driving quality and cost-effective member care through utilization and care management.

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Certified Coder (Risk Adjustment Experience Required) - REMOTE

Molina Healthcare · Full Time · 25 days ago

Molina Healthcare

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

Perform medical chart reviews to accurately report ICD-10 and CPT codes while ensuring compliance and minimizing risk. Provide training and education to the provider network regarding risk adjustment and coding updates.

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Investigator, Special Investigative Unit (Remote)

Molina Healthcare · Full Time · 25 days ago

Molina Healthcare

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

Provides investigative support to detect and prevent healthcare fraud, waste, and abuse (FWA) through data analysis and medical record reviews. Responsible for conducting end-to-end investigations, preparing referrals for law enforcement, and ensuring compliance with state and federal regulations.

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Director, Health Plan Operations (Must reside in Florida)

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States 💵 $97299 - $189K per year ⭐ 10+ yrs exp 💼 Healthcare

Leads the development and administration of state health plan operational functions to ensure contractual compliance and financial goals. Oversees claims, provider network administration, and member service strategies for Medicaid and Marketplace lines of business.

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Dental Director, Health Plan - REMOTE

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

Oversees utilization review and quality management activities to ensure the medical necessity and appropriateness of dental care services. Collaborates with senior leadership to develop strategic plans and clinical algorithms for cost-effective member care.

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Care Review Clinician (BH Licensed) - Remote in FL

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Conducts clinical service reviews for behavioral health members to ensure medical necessity and compliance with guidelines. Collaborates with multidisciplinary teams to manage care outcomes and process prior authorizations within required timelines.

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Care Review Clinician - Remote in FL

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States 💵 $24 - $46.81 per hour ⭐ 2-5 yrs exp 💼 Others

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

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Senior Program Manager - Remote CA

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Responsible for leading internal business projects and cross-functional teams from design through completion. This includes managing budgets, schedules, and external vendors while providing direction to program management staff.

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Program Director - Remote CA

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States 💵 $92474 - $180K per year ⭐ 5-10 yrs exp 💼 Product

Responsible for managing internal business projects and programs, overseeing governance across operational and strategic portfolios. The role involves directing schedules, budgets, and coordinating with C-level executives and the Corporate EPMO.

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Senior Health Educator- Pediatric Oncology/Hematology - Remote

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Develops and implements health education programs for members and providers within the Molina network. Oversees contract requirements and conducts data collection and monitoring to ensure quality standards are met.

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VP, Healthcare Services (Wisconsin)

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States ⭐ 10+ yrs exp 💼 Healthcare

Provides executive strategy and leadership to a multidisciplinary healthcare services team focusing on care management and utilization review. Accountable for financial results, clinical policy implementation, and ensuring compliance with regulatory and accreditation standards.

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AVP, Maternal Child Health Clinical Operations - REMOTE

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Provide strategic leadership and operational oversight for enterprise-wide maternal, newborn, and child health programs. Focus on reducing preventable morbidity and mortality while driving high-reliable, equitable care across perinatal and pediatric continuums.

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Representative, Pharmacy - Remote must reside in EST, PST or MST

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States ⭐ 0-2 yrs exp 💼 Healthcare

Provides customer service support for inbound and outbound pharmacy calls from members, providers, and pharmacies. Coordinates pharmacy prior authorization requests, appeals, and supports pharmacists with comprehensive medication reviews.

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(RN) Remote Care Manager - CA License req

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Provides comprehensive care management and coordination for members by developing individualized care plans and monitoring progress toward health outcomes. Collaborates with multidisciplinary teams and utilizes motivational interviewing to support member wellness and service integration.

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Manager, Healthcare Analytics - Databricks/SQL/Python - Remote

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States ⭐ 10+ yrs exp 💼 Software Development

Manage the Healthcare Analytics team by overseeing personnel, allocating project workloads, and ensuring the accuracy of data reports. Serve as a technical liaison between Corporate IT and Health Plan departments to support strategic and operational decision-making.

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Director Core Systems Strategies - QNXT/NetworX - Remote

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Leads the configuration team responsible for the implementation and maintenance of claims databases, benefits, and provider contracts. Focuses on operational efficiency, strategic process improvements, and ensuring compliance with federal and state regulations.

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Associate Analyst, Actuarial - REMOTE

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States 💵 $40851.44 - $88511.46 per year ⭐ 0-2 yrs exp 💼 Others

Provides entry-level support for actuarial functions by extracting and analyzing data to identify risks and estimate liabilities. Responsibilities include developing IBNR estimates, performing rate adequacy studies, and generating financial reports for senior leadership.

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Program Manager- Quality Compliance - Remote CA

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Product

Provides program management support for quality compliance, focusing on policy documentation, workflow management, and regulatory alignment. Acts as a primary liaison between internal departments to ensure adherence to NCQA requirements and state regulations.

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Senior Health Educator- Clinical Transplant Nurse- Remote

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Develops and implements health education and disease management programs for members within the Molina network and the broader community. Conducts data collection and monitoring to ensure compliance with NCQA and state/federal standards.

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Senior Health Educator- Pediatric Mental Health Nurse - Remote

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Develops and implements health education programs focused on pediatric behavioral health for members and providers. Conducts data collection and monitoring to ensure compliance with NCQA and HEDIS standards.

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Senior Health Educator- Pediatric Critical Care RN- Remote

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Develops and implements health education programs focusing on cardiovascular and kidney disease in a pediatric setting. Monitors member quality programs and ensures compliance with state, federal, and NCQA standards.

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Senior Health Educator- Registered Dietitian - Remote

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Develops and implements health education and disease management programs for a pediatric population within a managed care setting. Monitors quality programs and ensures compliance with NCQA and HEDIS standards through data collection and reporting.

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Senior Health Educator- Substance Use / Addiction and Recovery- Remote

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Develops and implements health education programs focusing on substance use and recovery for members and the community. Monitors quality programs and ensures compliance with state, federal, and NCQA standards.

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Senior Health Educator- Diabetes Care and Education Specialist (CDCES)- Remote

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Develops and implements health education programs focused on diabetes care for a pediatric population within a managed care setting. Monitors quality programs and ensures compliance with NCQA and HEDIS standards through data collection and reporting.

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Senior Health Educator- Asthma Educator - Remote

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Develops and implements health education programs focused on asthma care for a pediatric population within a managed care setting. Conducts data collection and monitoring to ensure compliance with NCQA and HEDIS standards.

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

Molina Healthcare · Full Time · a month 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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Director, Health Plan Provider Relations

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States 💵 $87569 - $189K per year ⭐ 10+ yrs exp 💼 Healthcare

Leads the health plan provider relations team to manage network development, adequacy, and provider education. Serves as the primary liaison between the business and contracted providers to ensure compliance and satisfaction.

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Manager, Member & Community Interventions (Remote in MS)

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Others

Manages the development and implementation of health plan member-focused initiatives to improve clinical quality outcomes across Medicare, Marketplace, and Medicaid. Oversees a portfolio of community interventions and builds strategic relationships with community-based organizations to drive health outcomes.

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Consultant, Medical Economics - REMOTE

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

Provide subject matter expertise in medical economics by extracting and analyzing data to identify financial risks and opportunities. Deliver data-driven insights and visualizations to senior leadership to improve financial performance and network initiatives.

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Risk & Quality Performance Manager (Remote)

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States 💵 $66456 - $129K per year ⭐ 2-5 yrs exp 💼 Others

Manage Risk and Quality performance initiatives by overseeing data collection, analytics, and reporting to improve health outcomes. Coordinate with stakeholders to ensure regulatory compliance and optimize HEDIS audit success.

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Analyst, Delegation Oversight (Remote)

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Provides analyst support for delegation oversight to ensure compliance with state, federal, and NCQA requirements. Responsible for gathering and analyzing compliance data from provider network delegates and supporting oversight committee meetings.

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Manager, Provider Engagement

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States 💵 $73102 - $142K per year ⭐ 5-10 yrs exp 💼 Others

Establish strategies and operational directions for risk adjustment and quality improvement to drive value-based care. Lead a team of Provider Engagement resources to ensure providers meet performance goals through coaching and consistent engagement.

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Manager, Medical Economics - REMOTE

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Leads the medical economics team in extracting and analyzing data to identify financial risks and opportunities. Collaborates with health plans to develop tracking tools and influence clinical strategy and decision-making.

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Senior Specialist, Quality Program Management & Performance (Remote)

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Implements and monitors healthcare quality improvement activities to ensure compliance with regulatory and program requirements. Leads project direction, prepares committee documentation, and manages quality audits and reporting.

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Specialist, Quality Program Management & Performance (Remote)

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Implements and monitors healthcare quality improvement activities to ensure compliance with state, federal, and NCQA requirements. Responsible for writing narrative reports, managing documentation, and collaborating across departments to remediate process gaps.

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Senior Specialist, Delegation Oversight (Remote)

Molina Healthcare · Full Time · a month ago

Molina Healthcare

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

Provides senior-level support for delegation oversight to ensure compliance with state, federal, and NCQA requirements. Responsibilities include performing assessments, monitoring delegate performance via scorecards, and developing corrective action plans.

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Senior Specialist, Quality Program Management & Performance (Remote)

Molina Healthcare · Full Time · a month ago

Molina Healthcare

🌎 United States 💵 $54922 - $107K per year ⭐ 2-5 yrs exp 💼 Others

Implements and oversees healthcare quality improvement activities to ensure compliance with state and federal regulatory requirements. Leads project direction, prepares committee documentation, and monitors key performance activities to identify process gaps.

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Manager, Medical Economics - REMOTE

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

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

Lead the refinement and stewardship of enterprise healthcare datasets to support Medical Economics reporting and operational workflows. Manage a team of analysts to enhance authorization data assets and collaborate cross-functionally to improve data quality and governance.

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Director, Reporting & Analytics - Medical Cost Grouper - Remote

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

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

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.

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Senior Specialist, National Quality Interventions/QI Compliance (Remote)

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Legal

Lead and implement healthcare quality improvement initiatives and ensure compliance with federal and state QI standards. This includes managing provider and member interventions, writing regulatory narrative reports, and coordinating NCQA accreditation surveys.

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HOPE Navigator (Social & Health Equity Navigator) Must Live In FL (Remote)

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States 💵 $24 - $46.81 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The HOPE Navigator supports member initiatives by addressing social determinants of health and facilitating access to community resources. They collaborate with interdisciplinary teams to implement pilot programs and ensure seamless care coordination for members.

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Care Review Clinician (RN) - Remote in FL

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The clinician is responsible for assessing 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 for members.

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Care Review Clinician (BH Licensed) - Remote in FL

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The clinician is responsible for conducting clinical service reviews to ensure medical necessity and compliance with behavioral health guidelines. They collaborate with multidisciplinary teams and providers to manage member care and facilitate appropriate treatment authorizations.

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Risk & Quality Reporting Analyst (Must have SQL, PowerBi, Databricks, Managed Care) - REMOTE

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States 💵 $47433 - $97362.61 per year ⭐ 2-5 yrs exp 💼 Software Development

The analyst designs and develops custom health plan reports to support risk and quality interventions, provider outreach, and outcome tracking. They also collaborate with internal departments to analyze data sets for trends, anomalies, and opportunities to improve HEDIS performance.

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Specialist, IRIS Consulting

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Others

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 program's data system.

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Manager, Process Improvement & Operational Excellence (Remote)

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

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

The manager leads a team responsible for process improvement initiatives to drive operational efficiency and increase customer satisfaction. They collaborate with senior leadership to develop organizational strategies and oversee the implementation of business process improvement capabilities.

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Senior Analyst, Medical Economics - REMOTE

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States 💵 $76425 - $149K per year ⭐ 2-5 yrs exp 💼 Healthcare

The Senior Analyst will extract and synthesize data to identify medical cost trends and financial risks while providing actionable recommendations to leadership. They will also lead projects, develop financial models for provider reimbursement, and collaborate with cross-functional teams to monitor medical intervention performance.

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Director, Medical Economics - REMOTE

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States 💵 $123K - $240K per year ⭐ 10+ yrs exp 💼 Healthcare

The Director leads a team responsible for medical economics analysis to identify financial risks and opportunities while driving trend performance reviews. They collaborate with health plans and shared services to implement trend mitigation strategies and track savings initiatives.

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Manager, Medical Economics - REMOTE

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States 💵 $101K - $198K per year ⭐ 5-10 yrs exp 💼 Healthcare

The manager oversees the medical economics team, ensuring accurate data analysis, reporting, and the identification of financial savings opportunities. They also lead trend review meetings and serve as a liaison between the enterprise information management team and Medicaid leadership.

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Care Manager, LTSS - Field travel in Jackson, La Crosse, & Monroe Counties, WI

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The Care Manager provides care coordination and support for members with high-need potential by developing and monitoring comprehensive care plans. They also conduct in-person assessments and facilitate interdisciplinary care team meetings to ensure quality and cost-effective service delivery.

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Lead Analyst, Healthcare Analytics - REMOTE

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

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

The Lead Analyst acts as a data steward responsible for designing and prototyping Medical Economics data assets. They bridge business needs and technical implementation by translating complex healthcare concepts into structured data requirements and logic.

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Health Plan Provider Relations Manager (Remote, Must Reside in NE)

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

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

The manager provides leadership for health plan provider relations, including network development, provider education, and strategic engagement. They serve as the primary point of contact for providers to ensure compliance with policies and resolve complex operational issues.

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Remote Medical Review Nurse (RN) - Must Work CST time zone

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States 💵 $29.05 - $67.97 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The Medical Review Nurse facilitates clinical reviews of medical claims and appeals to ensure medical necessity and accurate billing. They also serve as a clinical resource for utilization management and provide support for regulatory compliance and quality of care issues.

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Senior Project Manager (SME - Enrollment)

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States ⭐ 5-10 yrs exp 💼 Product

The Senior Project Manager is responsible for leading cross-functional enrollment projects from inception to delivery while acting as a subject matter expert. They will manage vendor relationships, analyze business requirements, and drive process improvements to ensure regulatory compliance and operational efficiency.

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Lead Analyst, Quality Analytics & Performance Improvement (Remote)

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

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

The Lead Analyst will design and develop reporting solutions for HEDIS audits, rate tracking, and performance improvement projects. They will also work cross-functionally to analyze complex data sets and provide technical training to team members.

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Specialist, IRIS Eligibility Screening (Milwaukee, WI)

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The Eligibility Screener conducts face-to-face Adult Long-Term Care Functional Screens for program participants to determine eligibility. They also verify screening results with consultants, agencies, and medical professionals while maintaining accurate documentation.

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Program Manager (Vendor Implementations)

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

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

The Program Manager is responsible for planning and directing project schedules, budgets, and cross-functional teams to support new vendor implementations. They also ensure governance standards are upheld while tracking performance metrics and managing program documentation.

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Care Manager, LTSS (RN) - (Remote in Boston, MA)

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States 💵 $30.37 - $59.21 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The Care Manager provides support for care coordination and collaborates with a multidisciplinary team to deliver integrated care for high-need members. Responsibilities include conducting comprehensive assessments, developing care plans, and monitoring member progress toward desired health outcomes.

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Associate Specialist, Appeals & Grievances - Remote TX

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States ⭐ 0-2 yrs exp 💼 Others

The associate provides entry-level support for claims activities by reviewing and resolving member and provider complaints in accordance with CMS standards. They are responsible for entering appeals, researching claims issues, and preparing formal responses to member grievances.

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Manager, Projects (Customer Experience) - REMOTE

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

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

The manager will oversee process improvement, organizational change, and project management initiatives to support enterprise growth and retention. They are responsible for maintaining operational cadence, managing governance forums, and ensuring consistent execution across health plans.

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Director, Health Plan Provider Contracts (Medicaid / Michigan Health Plan) - Remote in Michigan

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States 💵 $97299 - $189K per year ⭐ 10+ yrs exp 💼 Healthcare

Leads and directs the health plan provider network contracting team to support network strategy, financial performance, and operational goals. Negotiates complex provider contracts, including value-based payment models, while ensuring network adequacy and regulatory compliance.

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Senior Specialist, Provider Engagement (Remote)

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States 💵 $54922 - $107K per year ⭐ 2-5 yrs exp 💼 Others

The Senior Specialist implements provider engagement strategies to achieve quality and risk adjustment goals through coaching and collaboration. They track engagement activities, facilitate data exchanges, and support training for the Provider Engagement team.

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Investigator, Special Investigative Unit Coding (Remote)

Molina Healthcare · Full Time · 2 months ago

Molina Healthcare

🌎 United States 💵 $21.82 - $51.06 per hour ⭐ 2-5 yrs exp 💼 Others

The investigator provides support for special investigation unit activities by reviewing medical provider coding to identify fraud, waste, and abuse. They independently re-evaluate claims against medical records and manage caseloads to ensure accurate payment determinations and regulatory compliance.

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Pharmacy Technician CPhT (Remote)

Molina Healthcare · Full Time · 3 months ago

Molina Healthcare

🌎 United States 💵 $14 - $26.42 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The role involves reviewing and processing prior authorization requests for pharmacy services while ensuring compliance with established policies. You will also support pharmacy programs, resolve prescription claims, and communicate effectively with providers and members.

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Analyst, Business - SQL (Remote in Florida)

Molina Healthcare · Full Time · 3 months ago

Molina Healthcare

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

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.

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Senior Architect, Artificial Intelligence Security - AI Implemenation - Remote

Molina Healthcare · Full Time · 3 months ago

Molina Healthcare

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

This role provides senior-level support for designing, implementing, and maintaining the security framework for Artificial Intelligence and Machine Learning systems, serving as the subject matter expert for securing AI/ML workloads in Azure and Databricks environments. Key duties include designing secure AI/ML architectures, conducting threat modeling for AI-specific vulnerabilities like model inversion and prompt injection, and embedding automated security controls into the ML development lifecycle.

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Director, Data Management (EIM / Health Plan Analytics / AI & ML) - REMOTE

Molina Healthcare · Full Time · 3 months ago

Molina Healthcare

🌎 United States ⭐ 10+ yrs exp 💼 Software Development

This senior leadership role is responsible for defining and executing the enterprise data management strategy, modernization, and delivery across core health plan domains like claims, clinical, and member data. The director will lead the adoption of Databricks lakehouse architecture while ensuring data solutions are secure, compliant, and support advanced analytics and AI/ML use cases.

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Lead, Medicare Administration (Bids & Member Materials) (Remote)

Molina Healthcare · · 4 months ago

Molina Healthcare

🌎 United States ⭐ 2-5 yrs exp 💼 Others

This role provides lead-level support for Medicare and Medicare-Medicaid Plan (MMP) Duals products, focusing on developing and maintaining annual project timelines for timely completion. The position supports annual plan applications, PBP design, centralized beneficiary communications, and ensures operational processes, benefit configurations, and member communications are accurate and compliant.

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Senior GenAI Engineer/Data Scientist / Remote

Molina Healthcare · Full Time · 5 months ago

Molina Healthcare

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

The role involves designing, building, and deploying autonomous, LLM-powered systems to solve complex business problems. Responsibilities include developing agentic AI systems, optimizing RAG pipelines, and ensuring responsible AI practices.

big-data machine-learning python nosql sql cloud critical-thinking data-scientist

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