Qureos Mentor

Molina Healthcare

JOB DESCRIPTION Job Summary
 
Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
 
Essential Job Duties
 
<ul>
<li>Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.</li>
<li>Functions as a "hands-on" supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.</li>
<li>Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.</li>
<li>Trains and supports team members to ensure high-risk, complex members are adequately supported.</li>
<li>Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.</li>
<li>Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.</li>
<li>Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.</li>
<li>Local travel may be required (based upon state/contractual requirements).</li>
</ul>
Required Qualifications
 
<ul>
<li>At least 5 years health care experience, and at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. r equivalent combination of relevant education and experience.</li>
<li>Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.</li>
<li>Ability to manage conflict and lead through change.</li>
<li>Operational and process improvement experience.</li>
<li>Strong written and verbal communication skills.</li>
<li>Working knowledge of Microsoft Office suite.</li>
<li>Ability to prioritize and manage multiple deadlines.</li>
<li>Excellent organizational, problem-solving and critical-thinking skills.</li>
</ul>
Preferred Qualifications
 
<ul>
<li>Registered Nurse (RN). License must be active and unrestricted in state of practice.</li>
<li>Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.</li>
<li>Medicaid/Medicare population experience.</li>
<li>Clinical experience.</li>
<li>Supervisory/leadership experience.</li>
</ul>
#PJHPO3
 
#LI-AC1
 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
 Pay Range: $66,456 - $129,590 / ANNUAL
 <ul>
<li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.</li>
</ul>

Supv, Healthcare Services

JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
 
Essential Job Duties
 
<ul>
<li>Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.</li>
<li>Analyzes clinical service requests from members or providers against evidence based clinical guidelines.</li>
<li>Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.</li>
<li>Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.</li>
<li>Processes requests within required timelines.</li>
<li>Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.</li>
<li>Requests additional information from members or providers as needed.</li>
<li>Makes appropriate referrals to other clinical programs.</li>
<li>Collaborates with multidisciplinary teams to promote the Molina care model.</li>
<li>Adheres to utilization management (UM) policies and procedures.</li>
</ul>
Required Qualifications
 
<ul>
<li>At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.</li>
<li>Registered Nurse (RN). License must be active and unrestricted in state of practice.</li>
<li>Ability to prioritize and manage multiple deadlines.</li>
<li>Excellent organizational, problem-solving and critical-thinking skills.</li>
<li>Strong written and verbal communication skills.</li>
<li>Microsoft Office suite/applicable software program(s) proficiency.</li>
</ul>
Preferred Qualifications
 
<ul>
<li>Certified Professional in Healthcare Management (CPHM).</li>
<li>Recent hospital experience in an intensive care unit (ICU) or emergency room.</li>
</ul>
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
 Pay Range: $23.76 - $51.49 / HOURLY
 <ul>
<li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.</li>
</ul>

Care Review Clinician (RN)

JOB DESCRIPTION
 
Provides non-clinical administrative support to the care management function, and contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
 
Essential Job Duties
 
<ul>
<li>Facilitates administrative support including case assignment, member screening and scheduling, correspondence processing, data entry and telephone and clerical support for team facilitating care management related services for members.</li>
<li>Facilitates initial review of assigned case levels and assists in case management assignment to care managers.</li>
<li>Reviews data to identify principle member needs and works under the direction of the care manager to implement care plan.</li>
<li>Schedules member visits with care managers as needed.</li>
<li>Screens members according to Molina policies and processes and assists care management staff during process of identifying appropriate member services.</li>
<li>Coordinates required member services in accordance with member benefit plan.</li>
<li>Promotes communication both internally and externally to enhance effectiveness of care management services.</li>
<li>Processes member and provider correspondence.</li>
</ul>
Required Qualifications
 
At least 1 year of experience in an administrative support role in health care, or equivalent combination of relevant education and experience.
 
Strong attention to detail.
 
Problem-solving skills.
 
Working knowledge of Microsoft Office (Outlook, Word, Excel) or other comparable software.
 
Time-management and organizational skills.
 
Strong verbal and written communication skills.
 
Microsoft Office suite/applicable software program(s) proficiency.
 
Excellent customer service skills.
 
Preferred Qualifications
 
<ul>
<li>Certified Medical Assistant (CMA).</li>
</ul>
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
 
Pay Range: $17 - $34.88 / HOURLY
 <ul>
<li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.</li>
</ul>

Care Management Processor (Remote)

JOB DESCRIPTION
 
Job Summary
 
Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
 
Essential Job Duties
 
<ul>
<li>Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments.</li>
<li>Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals.</li>
<li>Conducts telephonic, face-to-face or home visits as required.</li>
<li>Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.</li>
<li>Maintains ongoing member caseload for regular outreach and management.</li>
<li>Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.</li>
<li>Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration.</li>
<li>Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.</li>
<li>Assesses for barriers to care, provides care coordination and assistance to member to address concerns.</li>
<li>May provide consultation, resources and recommendations to peers as needed.</li>
<li>Care manager RNs may be assigned complex member cases and medication regimens.</li>
<li>Care manager RNs may conduct medication reconciliation as needed.</li>
<li>25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications</li>
<li>At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.</li>
<li>Registered Nurse (RN). License must be active and unrestricted in state of practice.</li>
<li>Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.</li>
<li>Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA).</li>
<li>Demonstrated knowledge of community resources.</li>
<li>Ability to operate proactively and demonstrate detail-oriented work.</li>
<li>Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.</li>
<li>Ability to work independently, with minimal supervision and self-motivation.</li>
<li>Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations.</li>
<li>Ability to develop and maintain professional relationships.</li>
<li>Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.</li>
<li>Excellent problem-solving, and critical-thinking skills.</li>
<li>Strong verbal and written communication skills.</li>
<li>Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.</li>
</ul>
Preferred Qualifications
 
<ul>
<li>Certified Case Manager (CCM).</li>
</ul>
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
 Pay Range: $26.41 - $51.49 / HOURLY
 <ul>
<li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.</li>
</ul>

Care Manager (RN)

JOB DESCRIPTION Job Summary
 
Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
 
Essential Job Duties
 
<ul>
<li>Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments.</li>
<li>Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals.</li>
<li>Conducts telephonic, face-to-face or home visits as required.</li>
<li>Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.</li>
<li>Maintains ongoing member caseload for regular outreach and management.</li>
<li>Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.</li>
<li>Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration.</li>
<li>Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.</li>
<li>Assesses for barriers to care, provides care coordination and assistance to member to address concerns.</li>
<li>May provide consultation, resources and recommendations to peers as needed.</li>
<li>Care manager RNs may be assigned complex member cases and medication regimens.</li>
<li>Care manager RNs may conduct medication reconciliation as needed.</li>
<li>25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications</li>
<li>At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.</li>
<li>Registered Nurse (RN). License must be active and unrestricted in state of practice.</li>
<li>Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.</li>
<li>Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA).</li>
<li>Demonstrated knowledge of community resources.</li>
<li>Ability to operate proactively and demonstrate detail-oriented work.</li>
<li>Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.</li>
<li>Ability to work independently, with minimal supervision and self-motivation.</li>
<li>Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations.</li>
<li>Ability to develop and maintain professional relationships.</li>
<li>Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.</li>
<li>Excellent problem-solving, and critical-thinking skills.</li>
<li>Strong verbal and written communication skills.</li>
<li>Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.</li>
</ul>
Preferred Qualifications
 
<ul>
<li>Certified Case Manager (CCM).</li>
</ul>
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
 Pay Range: $26.41 - $59.21 / HOURLY
 <ul>
<li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.</li>
</ul>

Job Summary
 
Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information.
 
Job Duties
 
Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions.
 
Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare.
 
Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found.
 
JOB QUALIFICATIONS
 
Required Education: High School Diploma or GED.
 
Required Experience/Knowledge Skills & Abilities
 
<ul>
<li>Experience in a production or administrative role requiring self-direction and critical thinking.</li>
<li>Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems.</li>
<li>Experience with professional written and verbal communication.</li>
</ul>
Preferred Experience: 
<ul>
<li>Experience in the health care industry</li>
<li>Experiece with Provider credentialling</li>
</ul>
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
 Pay Range: $22.36 - $34.88 / HOURLY
 <ul>
<li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.</li>
</ul>

Assoc Specialist, National Credentialing (Provider Credentialing) Remote

JOB DESCRIPTION
 
Job Summary
 
Provides support for general accounting activities including management of accounts and records, transaction recording, financial data analysis, budgeting, forecasting, financial statement/accounting schedule reporting and auditing.
 
Essential Job Duties
 
<ul>
<li>Prepares journal entries, including Generally Accepted Accounting Principles (GAAP) and statutory reporting entries.</li>
<li>Prepares income and balance sheet statements, consolidated statements, and various other accounting statements and reports.</li>
<li>Analyzes monthly financial reports and records.</li>
<li>Coordinates accounting matters with other departments and functions throughout the business.</li>
<li>Facilitates financial data entry input to retrieve/display accounting information.</li>
<li>Prepare and review journal entries, ensuring accuracy and compliance with GAAP and healthcare regulations.</li>
<li>Calculate and validate financial accruals and estimates, ensuring accurate period-end recognition of expenses and liabilities.</li>
<li>Performs bank reconciliations and ensures proper coding of cash receipts/transfers.</li>
</ul>
Required Qualifications
 
<ul>
<li>At least 2 years of accounting experience, or equivalent combination of relevant education and experience.</li>
<li>Bachelor's degree in accounting or business.</li>
<li>Critical-thinking, problem-solving and analytical skills.</li>
<li>Ability to prioritize and manage multiple tasks.</li>
<li>Ability to work in a team setting.</li>
<li>Effective verbal and written communication skills.</li>
<li>Proficient in Microsoft Office suite products, key skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.</li>
</ul>
Preferred Qualifications
 
<ul>
<li>Certified Public Accountant (CPA).</li>
</ul>
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
 Pay Range: $19.64 - $42.55 / HOURLY
 <ul>
<li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.</li>
</ul>

Accountant - REMOTE

Join Molina Healthcare and explore 14   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Molina Healthcare

About Company

Supv, Healthcare Services

Care Review Clinician (RN)

Care Management Processor (Remote)

Care Manager (RN)

Care Manager (RN)

Assoc Specialist, National Credentialing (Provider Credentialing) Remote

Accountant - REMOTE