Job Description. JOB DESCRIPTION Job Summary. Provides senior level analyst support for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance. Essential Job Duties. Extracts and compiles data and information from various systems to support executive decision-making. Mines and manages information from large data source...
Job Description. JOB DESCRIPTION Job SummaryProvides 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. Completes comprehensive behavioral health assessments ...
Job Description. JOB DESCRIPTION Job SummaryProvides 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. Completes comprehensive behavioral health assessments ...
Job Description. Job Description. Work hours will be 7am-3:30pm PST M-F. Job Summary. Responsible for conducting various healthcare Healthcare claim audits including, but not limited to. vendor, focal, audit the auditor. Confirm that documentation is clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains to contracting (benefit and provi...
Job Description. JOB DESCRIPTION. Opportunity for TX licensed RN to join our DSNIP team to work with our members who are hospitalized and ready to be discharged. The RN hired for this position will work with the hospital discharge team to make sure that all the appropriate resources, doctor appointments, etc. are ready so that the transition out of the facility occurs smoothly, At this time, this position is fully remote, working from home, BUT t...
Job Description. Job Description. Job Summary. The Specialist, Member & Community Interventions implements new and existing clinical quality member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid) Executes health plan’s member and community quality focused interventions and programs in accordance with prescribed program standards, conducts data collection, monitors intervention activity including key perf...
Job Description. JOB DESCRIPTION Job Summary. Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements, accreditation standards and organizational performance standards - ensuring quality compliance and desired member outcomes and effective clinical operations. Contributes to overarching strategy to provide quality and cost-effective member care....
Job Description. JOB DESCRIPTION. Job Summary. Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis an...
Job Description. JOB DESCRIPTION. Job Summary. The Program Manager for the Nevada Health Plan provides analytical insights to identify opportunities for improvement in provider and member experience. Provides support to Molina functional areas through program management, including policy, workflow and process documentation, management of program controls, vendor practices, budgets, governance frameworks, playbooks and best practices, and champion...
Job Description. JOB DESCRIPTION. Job Summary. Provides support to Molina functional areas through program management, including policy, workflow and process documentation, management of program controls, vendor practices, budgets, governance frameworks, playbooks and best practices, and champion networks, as applicable. Job Duties. Responsible for ensuring well-documented policies, workflows, program controls, internal and third-party practices,...
Job Description. JOB DESCRIPTION Job SummaryLeads and manages a team of medical directors delivering oversight and expertise in appropriateness and medical necessity of services provided to members - ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties. Leads a team of medical directors responsible for assessing...
