Job Details. Job Description. Job Description. Job Summary. Responsible for all the aspects of architecture, design and implementation of Data Management solution using Big Data platform on Cloudera or Hortonworks and other areas of enterprise application platforms. Knowledge/Skills/Abilities. Convert concepts to technical architecture, design and implementation. Provide guidance on choosing ideal Architecture, Evaluating tools and Frameworks, de...
JOB DESCRIPTION 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. Essenti...
Job Description. Job Summary. Responsible for the Management of 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 ...
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 sources. Analyzes claim...
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. Completes comprehensive assessments of members per regulated timeline...
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. Completes comprehensive assessments of members per regulated timeline...
JOB DESCRIPTION Job Summary. Provides analyst support for actuarial function activities including extracting, analyzing, and synthesizing data from various sources to identify risks. Estimates liabilities, establishes premium rates, and supports financial analysis and reporting. Essential Job Duties. Collaborates with actuarial team to complete incurred but not reported (IBNR) estimates and rate adequacy studies, and documents assumptions. Analyz...
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 provider), network man...
Job Description. Opportunity for an experienced Care Manager with either a Bachelor’s or Master’s degree to join Molina as a Case Manager working with our Medicaid members. The service delivery area for this position is concentrated in Dallas and Guthrie Counties in Iowa. Part of the responsibilities of the role is to conduct face-to-face meetings with the members in their homes, completing assessments needed for determining the types of services...
Job Description. Job Summary. The Manager, Business Development, Facilitated Enrollments, is responsible for for overseeing daily operations and driving individual and team performance. The Manager will lead a team of Facilitated Enrollers in a designated region(s) making data-informed decisions to drive performance, resource allocation and lead generation. This is a field-based leadership role that is accountable for meeting sales and enrollment...
Job Description. Job Summary. The Marketplace Facilitated Enroller (MFE) is responsible for identifying prospective members that do not have health insurance and assisting with the enrollment process ultimately making it easier for them to connect to the care they need. The MFE conducts interviews and screens potentially eligible recipients for enrollment into Government Programs such as Medicaid/Medicaid Managed Care, Child Health Plus and Essen...
Job Description. Job Summary. The Marketplace Facilitated Enroller (MFE) is responsible for identifying prospective members that do not have health insurance and assisting with the enrollment process ultimately making it easier for them to connect to the care they need. The MFE conducts interviews and screens potentially eligible recipients for enrollment into Government Programs such as Medicaid/Medicaid Managed Care, Child Health Plus and Essen...
