Job Summary Molina’s HEDIS/Quality Improvement Medical Records Collector will work collaboratively in outreaching to providers in order to pursue medical records via phone call, fax, mail, electronic medical record system retrieval and direct onsite pick up, for the HEDIS projects. Job Duties • Under the direction of the national and/or regional lead, the Medical Records Collector supports the annual HEDIS audit and other HEDIS like audits, by organizing provider outreach, pursuit, collection, and upload of provider medical records into the …

Job Summary Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, planning, and issue/risk management. KNOWLEDGE/SKILLS/ABILITIES Proven depth of understanding and demonstrable results for effective management of intermediate to large-scale projects, using prescribed approach(as). Solid knowledge of methods and techniques involved in project management initiatives. Work with IT and business teams to set up/ amend new/ existing healthplans and new lines of business. Must have experience in …

JOB DESCRIPTION Job Summary Molina Pharmacy Services/Management staff work to ensure that Molina members, providers, and pharmacies have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan’s pharmacy benefit programs in accordance with all federal and state laws. Jobs in this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy …

Job Summary Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. KNOWLEDGE/SKILLS/ABILITIES Trains staff on configuration functionality, enhancements, and updates. …

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. KNOWLEDGE/SKILLS/ABILITIES • Responsible for owning, handling and resolving complex issues. Effectively manage escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure. • …

Job Summary Molina Pharmacy Services/Management staff work to ensure that Molina members have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan’s pharmacy benefit programs in accordance with all federal and state laws. Jobs in this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services …

JOB DESCRIPTION Job Summary Molina Healthcare is seeking a Lead Engineer, Applications (Pega) to elevate our enterprise application landscape. We are looking for a highly experienced, self-motivated professional with technology and software development experience, including deep expertise in Pega-based solutions and enterprise system design. As a senior technical leader, you will drive architectural decisions and ensure that our applications are scalable, secure, and aligned with strategic objectives. Applies and promotes key principles (e.g., stability, scalability, performance, security, compatibility, re-use), helping …

JOB DESCRIPTION Schedule: Mon-Fri, 8 hour shift. Available shifts: 8am-5pm PST, 9am-6pm PST, 10am-7pm PST Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of …

Job Summary The Care Connections Representative primary focus is to conduct outbound calls to Molina members and schedule appointments with our Nurse Practitioners. As part of Molina’s benefit package, the appointments are for preventive care services delivered in the home, community, and nursing facility settings. Job Duties Conduct outbound calls to Molina members and schedule appointments with our Nurse Practitioners Understands and strives to meet or exceed call center metrics while providing high quality consistent customer service Removes barriers for …