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 customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences. Job Duties. Provide service support to members and/or providers using one or more contac...
JOB DESCRIPTION Job SummaryProvides customer service support for inbound/outbound Medication Therapy Management (MTM) pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job Duties. Handles and records inbound/outbound pharmacy calls with members, providers, pharmacists, pharmacies and tec...
Job Description. Job Summary. Responsible for analysis of Medicaid and Medicare financial reports, trend, and opportunities. Includes evaluation of and recommendations relating to business opportunities, Medicare bids, investments, financial regulations, and similar financial projects or programs. Duties include gathering, interpreting, and evaluating financial information across the organization. generating forecasts and analyzes trends. Creatin...
JOB DESCRIPTION. Job Summary. Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences. Job Duties. Provide service support to members and/or providers using one or more contac...
The Clinical Services Auditor performs auditing of clinical staff in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM) and monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system and process audits, as needed. This position will be supporting our Washington State Plan. We are seeking a candi...
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...
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...
For this position we are seeking a (RN) Registered Nurse who must live and have a current active unrestricted RN license in the state of MI. This position will support our MMP (Medicaid Medicare Population) will be supporting DSNP. This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent compu...
For this position we are seeking a RN or a Licensed Social Worker who must live and have a current active unrestricted license (LMSW, LBSW, LLMSW) in the state of MI. This position will support our MMP (Medicaid Medicare Population). This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent com...
Job Description. Job Summary. Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs. Job Duties. Provides peer support services for members with behavioral health issues, psychiatric disorders, drug and/or alcohol dependence, and physical illne...
JOB DESCRIPTION Job Summary. Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job...
