Qureos Mentor

Molina Healthcare

Job Description
 Job Summary
 Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide.
 Knowledge/Skills/Abilities
 
Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines.
 Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.
 Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management.
 Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions.
 Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related.
 Coordinate, facilitate and document audit walkthroughs.
 Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal.
 Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed..
 Ability to write SQL queries
 Experience with QNXT configuration
 Experience with troubleshooting and analyzing issues.
 Experience working in a Medicare environment is highly preferred.
 Claims adjudication experience is highly preferred.
 
Job Qualifications
 Required Education
 Associate's Degree or two years of equivalent experience
 Required Experience
 <ul>
<li>Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations:</li>
<li>Analytical experience within managed care operations.</li>
<li>Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions.</li>
</ul>
Preferred Education
 Bachelor's Degree
 Preferred Experience
 <ul>
<li>Six years proven analytical experience within an operations or process-focused environment.</li>
<li>Previous audit and/or oversight experience.</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: $77,969 - $116,835 / ANNUAL
 <ul>
<li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.</li>
</ul>

QNXT Configuration Analyst

IRIS Consultant
 
JOB DESCRIPTION
 
Job Summary
 
Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long-term health care needs? Then TMG wants to hear from you!
 
We’re currently looking for someone with a social services or human services background to join our team. This is a remote position, where you will partner with people in your community who are enrolled in the Wisconsin IRIS Program and the TMG IRIS Consultant Agency. While your office will be home-based, you will have regularly scheduled visits with IRIS participants in their home and community.
 
As an IRIS Consultant (IC), you will build relationships with the people you partner with and help them navigate and get the most out of the Wisconsin IRIS program – a Medicaid long-term care option for older adults and people with disabilities. You can learn more about the IRIS program on the Wisconsin Department of Health Services website here . Together, you will identify the long-term care goals of the people enrolled in IRIS, and find creative ways to achieve those goals.
 
ICs play an important role in helping people of various backgrounds and abilities live the lives that they choose. In fact, people constantly tell us how supportive our ICs are and what a positive impact our ICs have had on their lives! Successful candidates for this position will be compassionate, genuine, resourceful partners with an eye for high quality work, and who are excited to work side-by side with people enrolled in IRIS.
 
As an IC, you will connect people to the resources available in their community. You will also help them develop customized IRIS plans for achieving their goals related to employment, housing, health, safety, community membership, transportation, and lasting relationships. While you will have a routine for the work that you do, no two days are alike!
 
TMG wants to find the best possible candidates, so we created this Realistic Job Preview to provide you with an inside look at the position and our organization. Find out more about the IRIS Consultant position by clicking on the link and then reviewing the job posting below.
 
TMG is committed to maintaining a diverse and inclusive workforce and prioritizes helping staff have a good work/life balance. Even though the position is remote, you’ll have lots of support from your TMG team and coworkers across the organization. If this sounds like the job for you, apply today!
 
KNOWLEDGE/SKILLS/ABILITIES
 
Required to meet in person with the IRIS participant a minimum of four times per year, with one required annual visit in the home of the participant. Because IRIS is a self-directed program, it is important for ICs to be available upon the request of the participant.
 
Responsible for providing program orientation to new participants. During this time, participants will learn their rights and responsibilities as someone enrolled in the IRIS program, including verifying legal documents, completing employee paperwork and the responsible use of public dollars.
 
Explore a broad view of the participant's life, including goals, important relationships, connections with the local community, interest in employment, awareness of the Self-Directed Personal Care option, and back-up support plans.
 
Assist participants in identifying personal outcomes and ensure those outcomes are being met on an ongoing basis, all while staying within the participant's IRIS budget and within the requirements of the IRIS program determined by the Department of Health Services (DHS).
 
Responsible for documenting all orientation and planning activities within the IRIS data system (WISITs) within 48 business hours of the visit with the participant.
 
Research community resources and natural supports that will fit the individual outcomes for each participant and share that information with them as it becomes available.
 
Responsible for documenting progress and changes as needed within the plan and the data system anytime a modification is requested by a participant.
 
Budget Amendment or One-Time Expense paperwork may be required depending upon factors associated with the participant and their individual IRIS budget.
 
Educate participants on how to read and interpret their monthly budget reports to ensure that participants operate within their budget. Being a liaison between the Fiscal Employer Agency and the IRIS Consultant Agency is also a large part of the position, which includes assisting participants with provider billing, seeking support brokers, tracking receipts, ensuring their workers are paid and mitigating areas of potential risk or conflicts of interest.
 
Responsible to develop engaged and trusting relationships with participants and communicate program changes and compliance effectively.
 
Responsible to maintain confidentiality and HIPPA compliance.
 
Work collaboratively with other IRIS Consultant Agency staff in order to ensure a successful implementation of participants' plans.
 
Attend in-person monthly team meetings with other ICs and their supervisor. In addition, weekly IC and IRIS Consultant Supervisor phone check-ins may occur, along with other duties as assigned.
 
Required Qualifications
 
<ul>
<li>At least 2 years experience in health care, preferably in care coordination, and at least 1 year of experience serving target groups of the IRIS program (adults with intellectual/physical disabilities or older adults), or equivalent combination of relevant education and experience.</li>
<li>Bachelor’s degree in a social work, psychology, human services, counseling, nursing, special education, or a closely related field (or four years of commensurate experience if no degree).</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 develop positive and effective work relationships with coworkers, clients, participants, providers, regulatory agencies and vendors.</li>
<li>Ability to work independently with minimal supervision and demonstrate self-motivation.</li>
<li>Demonstrated knowledge of long-term care programs.</li>
<li>Familiarity with principles of self-determination.</li>
<li>Problem-solving and critical-thinking skills.</li>
<li>Excellent time-management and prioritization skills.</li>
<li>Ability to focus on multiple projects simultaneously and adapt to change.</li>
<li>Ability to develop and maintain professional relationships and work through challenging situations.</li>
<li>Comfortable working within a variety of settings with ability to adjust style as needed to work with diverse populations, various personalities, and personal situations.</li>
<li>Demonstrated knowledge of community resources.</li>
<li>Proactive and detail-oriented.</li>
<li>Excellent verbal and written communication skills.</li>
<li>Microsoft Office suite/applicable software program(s) proficiency.</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: $18.04 - $35.17 / HOURLY
 <ul>
<li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.</li>
</ul>

IRIS Consultant (Milwaukee County, WI)

<div>
 
 Job Description
 
 
 
 
 Job Summary
 
 
 
 Molina Healthcare is seeking a seasoned Business Analyst to support cross-functional initiatives across all lines of business. This role will collaborate with teams in various departments (Claims, Enrollment, Provider Network, IT, Compliance, etc.) to analyze business needs, document requirements, and drive operational improvements. The ideal candidate will bring strong analytical skills, healthcare experience, and a deep understanding of Centers for Medicare and Medicaid Services (CMS) programs and regulations.
 
 
 
 Knowledge/Skills/Abilities
 
 
 
 <ul>
 <li>
 Articulate requirements into concise and clear directions for project members (Business Owners, Developers, Testers, etc.) to understand and execute
 </li>
 <li>
 Facilitate collaboration across departments to ensure alignment and compliance
 </li>
 <li>
 Ingenuity to gather requirements for system enhancements and operational changes from simple to complex projects
 </li>
 <li>
 Ability to analyze intricate business processes and data to identify gaps
 </li>
 <li>
 Utilize researched data and IT/Healthcare knowledge to recommend viable and sustainable solutions
 </li>
 <li>
 Monitor performance and contribute to continuous improvement efforts
 </li>
 <li>
 Strong communication and stakeholder engagement skills extending to executive levels
 
 
 </li>
 </ul>
 
 Job Qualifications
 
 
 
 
 Required Education
 
 
 
 <ul>
 <li>
 Bachelor's degree in Business, Healthcare Administration, or related field or equivalent work experience
 
 
 </li>
 </ul>
 
 Required Experience
 
 
 
 <ul>
 <li>
 2-5 years of experience in business analysis, preferably in a managed care or CMS environment
 </li>
 <li>
 Familiarity with Agile methodologies and tools like Jira or SharePoint
 
 
 </li>
 </ul>
 
 Preferred License, Certification, Association
 
 
 
 <ul>
 <li>
 Six Sigma, CBAP, or similar certification preferred
 
 
 </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: $77,969 - $128,519 / ANNUAL
 
 
 <ul>
 <li>
 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
 </li>
 </ul>
</div>

Business Analyst, PMO

Join Molina Healthcare and explore 3   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

QNXT Configuration Analyst

IRIS Consultant (Milwaukee County, WI)

Business Analyst, PMO