Qureos Mentor

Molina Healthcare

Molina Healthcare is a FORTUNE 500 company dedicated to government-sponsored health care programs for eligible families and individuals. The company partners with state governments to provide a variety of health care services, including Medicaid and Medicare plans, across multiple states. Molina Healthcare aims to improve health outcomes through community partnerships and innovative health solutions.

<div>Job Description 


Job Summary 
The Specialist, Patient Care Delivery is a multi-disciplinary healthcare professional who delivers high-quality, compassionate care to health plan members in their homes. This role combines clinical expertise, cultural sensitivity, and excellent communication to ensure each member receives personalized and efficient care in a comfortable setting. 


Job Duties

In-Home Clinical Care
<ul>
<li>Travels to members&rsquo; homes to conduct scheduled health visits according to license-specific scope of practice. Drives up to 120 miles a day on a regular basis to a variety of locations within the assigned region. Drives beyond 120 miles as part of extended mileage may be required on special project days. Special projects may include an overnight hotel stay</li>
<li>Collects and documents vital signs, medical history, and current medications in the secure electronic health record (EHR).</li>
<li>Supports providers during in-home physical assessments and procedures (e.g., diabetic eye exams, bone density screens, vision/hearing screens).</li>
<li>Administers injections, draws blood, and performs point-of-care testing (e.g., urine dipstick, glucose, pregnancy tests).</li>
<li>Maintains inventory of mobile supplies and ensures safe handling, sterilization, and disposal of equipment and medical waste.</li>
<li>Provides care and performs tasks aligned with credentialed role.</li>
</ul>
Member-Centered Engagement
<ul>
<li>Educates and guides members on care plans, medications, and healthy lifestyle practices.</li>
<li>Communicates respectfully and effectively with diverse member populations, demonstrating cultural competence and emotional intelligence.</li>
<li>Ensures member privacy and upholds HIPAA compliance within home-based environments.</li>
<li>Builds trust to encourage member participation and long-term wellness engagement.</li>
</ul>
Mobile Administrative Support
<ul>
<li>Organizes and confirms in-home visit schedules and travel routes.</li>
<li>Completes lab requisitions, coordinates specimen pickup, and manages referrals or follow-up needs.</li>
<li>Accurately documents all care interactions and assists with coding or billing workflows as needed.</li>
<li>Serves as a field liaison to the broader care team, identifying changes in member status and escalating appropriately.</li></ul> 


Job Qualifications

REQUIRED QUALIFICATIONS:
<ul>
<li>Active license or certification as one of the following: Medical Assistant (MA), Certified Nursing Assistant (CNA), Licensed Vocational/Practical Nurse (LVN/LPN), or Phlebotomist.</li>
<li>Experience-based clinical proficiency aligned with credentialed role.</li>
<li>Completion of training program applicable to credential.</li>
<li>Current CPR certification.</li>
<li>Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements.</li>
<li>If not currently certified for phlebotomy, must obtain certification within 6 months of hire.</li>
<li>Outstanding communication and interpersonal skills.</li>
<li>Ability to work independently and adapt to varying home conditions.</li>
<li>Knowledge of clinical safety, infection control, and emergency response.</li>
<li>Comfort using technology for documentation, scheduling, and coordination.</li>
<li>Commitment to continuous professional development and member-first care.</li>
</ul>
PREFERRED QUALIFICATIONS:
<ul>
<li>Bilingual (English/Spanish or other language relevant to member population).</li>
<li>Experience with Medicaid/Medicare populations.</li>
<li>Familiarity with mobile EHR systems (e.g., Epic, QNXT).</li>
<li>Prior experience in home health or mobile care delivery.</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.</div>

Specialist, Patient Care Delivery (San Diego, CA)

M-F 8am -5pm 50% travel subject to change JOB DESCRIPTION Job SummaryProvides support for community-based member advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing health care needs. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties <ul><li>Engages with members as an advocate and resource to support management of health care needs.</li><li>Collaborates with and supports the health care services team by providing non-clinical paraprofessional duties in the field to include meeting with members in their homes, nursing homes, shelters, provider offices, etc.</li><li>Empowers members by helping them navigate and maximize their health plan benefits. Assistance may include: scheduling appointments with providers, arranging transportation for health care visits, getting prescriptions filled and following-up with members on missed appointments.</li><li>Assists members in accessing social services such as community-based resources for housing, food, employment, etc.</li><li>Provides outreach to locate and/or provide support for disconnected members with special needs.</li><li>Conducts research with available data to locate members that Molina has been unable to contact (e.g., reviewing internal databases, contacting member providers or caregivers or travel to last known address or community resource locations such as homeless shelters, etc.)</li><li>Participates in ongoing or project-based activities that may require extensive member outreach (telephonic and/or face-to-face).</li><li>Guides members to maintain Medicaid eligibility and with other financial resources as appropriate.</li><li>50-80% local travel may be required (based upon state/contractual requirements).</li></ul>Required Qualifications&bull; At least 1 year of health care experience, preferably working with underserved or special needs populations with varied health, economic and educational circumstances, or equivalent combination of relevant education and experience. <ul><li>Community Health Worker (CHW) certification may be required for certain states (dependent upon contractual requirements).</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>Ability to multi-task applications while speaking with members.</li><li>Excellent customer service skills.</li><li>Organizational and time-management skills.</li><li>Ability and willingness to learn other lines of business, programs and relevant software systems/applications.</li><li>Excellent verbal and written communication skills.</li><li>Microsoft Office suite/applicable software program(s) proficiency.</li></ul>Preferred Qualifications <ul><li>Community Health Worker (CHW) certification (for states other than Ohio, Florida and California, where it is required).</li><li>Certified Medical Assistant (CMA).</li><li>Bilingual based on community need.</li><li>Familiarity with health care systems.</li><li>Knowledge of community-specific culture.</li><li>Experience with/or knowledge of health care systems, community resources, social services, and/or health education.</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: $16.4 - $31.97 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Community Connector - Hybrid Must reside in Houston, TX

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/VPay Range: $23.76 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Care Review Clinician (RN) Remote

<div>
 
 JOB DESCRIPTION Job Summary
 
 
 
 Provides screening, preventive primary care and medical care services to members - primarily in non-clinical settings where members feel most comfortable, including in-home, community and nursing facilities and &ldquo;pop up&rdquo; clinics. 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>
 Provides general medical care and care coordination to various and/or specific patient member populations &ndash; adult, women&rsquo;s health, pediatric, and geriatric.
 </li>
 <li>
 Performs comprehensive evaluations including history and physical exams for gaps in care and preventive assessments.
 </li>
 <li>
 Addresses both chronic and acute primary care complaints, and demonstrates ability to ascertain medical urgency.
 </li>
 <li>
 Establishes and documents reasonable medical diagnoses.
 </li>
 <li>
 Seeks specialty consultation as appropriate.
 </li>
 <li>
 Orders/performs pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptoms; works within an environment of limited resources and therefore uses diagnostic tests judiciously and appropriately.
 </li>
 <li>
 Understands when a member's needs are beyond their scope of knowledge and when physician oversight is needed.
 </li>
 <li>
 Creates and implements a medical plan of care.
 </li>
 <li>
 Schedules appointments for visits when appropriate.
 </li>
 <li>
 Provides post-discharge coordination to reduce hospital readmission rates and emergency room utilization.
 </li>
 <li>
 Performs face-to-face in-person visits in a variety of settings including in-home, skilled nursing facilities, and public locations.
 </li>
 <li>
 Performs face-to-face visits via alternative modalities based on business need, leadership direction and state regulations.
 </li>
 <li>
 Orders bulk laboratory orders to target specific member populations.
 </li>
 <li>
 Performs alternating on-call coverage to triage any urgent lab results and pharmacy inquiries and develops appropriate plans of care.
 </li>
 <li>
 Participates in community-based &ldquo;pop up clinics&rdquo; to build relationships with communities, and address gaps in health care.
 </li>
 <li>
 Drives up to 120 miles a day on a regular basis to a variety of locations within the assigned region. Drives beyond 120 miles as part of extended mileage may be required on special project days. Special projects may include an overnight hotel stay.
 </li>
 <li>
 Obtains and maintains cross-state license in other states besides home state based on business need.
 </li>
 <li>
 Collaborates with fellow nurse practitioners to develop best practices to perform work duties efficiently and effectively.
 </li>
 <li>
 Actively participates in regional meetings.
 </li>
 <li>
 May prescribe medications and perform procedures as appropriate.
 </li>
 <li>
 Performs timely medical records documentation in electronic medical record (EMR) computer system.
 </li>
 <li>
 On occasion, may be required to walk flights of stairs while carrying up to 50 lbs. of equipment.
 </li>
 <li>
 Engages in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician to the degree required by state laws.
 </li>
 <li>
 Local travel required (based upon state/contractual requirements).
 
 
 </li>
 </ul>
 
 Required Qualifications
 
 
 
 <ul>
 <li>
 At least 1 year of experience as a nurse practitioner, or equivalent combination of relevant education and experience.
 </li>
 <li>
 Active and unrestricted national certification from one of the following organizations: American Academy of Nurse Practitioners (AANP) or American Nurses Credentialing Center (ANCC).
 </li>
 <li>
 Current state-issued license to practice as a Family Nurse Practitioner (FNP). License must be active and unrestricted in state of practice.
 </li>
 <li>
 Prescriber Drug Enforcement Agency (DEA) license with authority to prescribe per state qualifications. License must be active and unrestricted in state of practice.
 </li>
 <li>
 Current Basic Life Support (BLS) certification.
 </li>
 <li>
 Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements.
 </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 demonstrate self-motivation.
 </li>
 <li>
 Responsive in all forms of communication.
 </li>
 <li>
 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; 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(s) proficiency, and electronic medical record (EMR) experience.
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 Experience as a registered nurse or nurse practitioner in a home health, community health or public health setting.
 </li>
 <li>
 Experience in home health as a licensed clinician, especially in management of chronic conditions.
 </li>
 <li>
 Experience with underserved populations facing socioeconomic barriers to health care.
 </li>
 <li>
 Immunization and point of care testing skills.
 </li>
 <li>
 Bilingual.
 
 
 </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: $88,453 - $198,356 / ANNUAL
 
 
 <ul>
 <li>
 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
 </li>
 </ul>
</div>

Field Nurse Practitioner (Spokane, WA)

<div>
 JOB DESCRIPTION Job Summary Provides 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>
 #PJHS3
 
 
 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>
</div>

Care Review Clinician (RN)

<div>
 
 Job Description
 
 
 
 Candidates
 
 must reside in Florida
 
 and hold an active, unrestricted nursing license in the state. This is a hybrid position requiring
 
 approximately 20% travel
 
 to hospital settings to support member needs. Applicants must have a minimum of two years of case management experience, specifically working with pediatric and adolescent populations.
 
 
 
 Job Summary
 
 
 
 Provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from hospital admission to all other settings. Strives to ensure that best possible services are available to members at time of hospital discharge, and focuses on goal to reduce member readmissions. Contributes to overarching strategy to provide quality and cost-effective member care.
 
 
 
 Essential Job Duties
 
 
 
 <ul>
 <li>
 Follows member throughout a 30 day program that starts at hospital admission and continues oversight through transitions from acute setting to all other settings, including nursing facility placement/private home, with the goal of reduced readmissions.
 </li>
 <li>
 Ensures safe and appropriate transitions by collaborating with the hospital discharge planner, as well as collaborating with hospitalists, outpatient providers, facility staff, and family/support network.
 </li>
 <li>
 Ensures member transitions to setting with adequate caregiving and functional support, as well as medical and medication oversight support.
 </li>
 <li>
 Works with participating ancillary providers, public agencies or other service providers to make sure necessary services and equipment are in place for safe transition.
 </li>
 <li>
 Conducts face-to-face visits of all members while in the hospital and, home visits high-risk members post-discharge as needed.
 </li>
 <li>
 Coordinates care and reassesses member needs using the Coleman Care Transition model post-discharge.
 </li>
 <li>
 Educates and supports member focusing on seven primary areas (Transition of Care Pillars): medication management, use of personal health record, follow-up care, signs and symptoms of worsening condition, nutrition, functional needs and or home and community-based services, and advance directives.
 </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>
 Facilitates interdisciplinary care team meetings (ICT) and collaboration.
 </li>
 <li>
 Provides consultation, recommendations and education as appropriate to non-behavioral health care managers.
 </li>
 <li>
 40-50% local travel may be required (based upon state/contractual requirements).
 
 
 </li>
 </ul>
 
 Required Qualifications
 
 
 
 <ul>
 <li>
 At least 2 years experience in health care, with at least 1 year of experience in hospital discharge planning, care management 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>
 Knowledge of or experience using the Care Transitions Intervention (CTI) or similar model.
 </li>
 <li>
 Background in discharge planning and/or home health.
 </li>
 <li>
 Demonstrated knowledge of community resources.
 </li>
 <li>
 Proactive and detail-oriented.
 </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 demonstrate self-motivation.
 </li>
 <li>
 Responsive 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>
 Excellent verbal and written communication skills.
 </li>
 <li>
 Microsoft Office suite/other applicable software program(s) proficiency.
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 Transitions of care sub-specialty certification and/or Certified Case Manager (CCM).
 </li>
 <li>
 Hospital discharge planning or home health experience.
 
 
 </li>
 </ul>
 #PJHPO3
 
 
 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>
</div>

Transition of Care Coach (RN) - FL

JOB DESCRIPTION Job Summary Provides senior level analyst support for finance activities including financial analysis, reporting, forecasting, trending and modeling to support planning for future business decisions such as new product development, marketing strategies and investments. This position is part of the health plan finance team and supports the financial management of the IL health plan. The individual in this role will assist with the monthly close process, forecasting and budgeting, regulatory reporting, developing financial models, and responding to any ad hoc reporting requests for leadership decision-making support. Essential Job Duties <ul><li>Gathers, interprets and evaluates financial information; generating forecasts and analyzing trends in sales, finance and other areas of business.</li><li>Financial analysis including budgeting, forecasting, close reporting, and month-end variance analysis</li><li>Complete accurate and timely financial reporting and identify, investigate, and resolve discrepancies</li><li>Uses financial data to evaluate and make recommendations relating to business opportunities, product development, marketing strategies, investments, financial regulations, and similar financial projects or programs.</li><li>Forecasts and monitors economic benefits of Molina investments in infrastructure and operations (enhancements in operating efficiency and effectiveness).</li><li>Assists the information technology department with financial modeling, budgeting, benchmarking analysis and variance analysis as needed.</li><li>Develops policies and procedures to support finance activities.</li><li>Ability to prioritize effectively to multi-task under tight deadlines</li></ul>Required Qualifications <ul><li>At least 3 years of finance experience, or equivalent combination of relevant education and experience.</li><li>Bachelor&rsquo;s degree in finance or related field or equivalent combination of education and experience.</li><li>Strong critical-thinking and attention to detail.</li><li>Ability to effectively collaborate with technical and non-technical stakeholders.</li><li>Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.</li><li>Effective verbal and written communication skills.</li><li>Advanced experience Proficient in Microsoft Office suite products, including Excel, PowerPoint (VLOOKUPs and pivot tables), and applicable software program(s) proficiency.</li></ul>Preferred Qualifications <ul><li>Strong SQL or Databricks knowledge (technical skills)</li><li>Previous finance experience in managed care</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: $54,373.27 - $117,808.76 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Senior Analyst, Finance (Illinois Health Plan, SQL Preferred) - REMOTE

Join Molina Healthcare and explore 16   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.