Long Beach, California, United States · Remote OK
$83k–$164k/yr
***Remote and must live in Washington*** JOB DESCRIPTION Job Summary Provides subject matter expertise and leadership for health plan provider network complex contracting activities. Supports network strategy and develop…
Skills: Contract Negotiation, Value-Based Payment Methodology, Provider Relationship Management, Financial Analysis, Network Adequacy
Long Beach, California, United States · Remote Solely
JOB DESCRIPTION Job SummaryProvides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overar…
Skills: Medical Coding, ICD-10, CPT Codes, Risk Adjustment, Chart Reviews
Long Beach, California, United States · Remote OK
$66k–$143k/yr
JOB DESCRIPTION Job Summary The Lead Analyst serves as a data steward with deep subject matter expertise, responsible for designing and prototyping Medical Economics data assets that are clearly defined and fit for use. …
Skills: SQL, Data Stewardship, Healthcare Analytics, Medical Economics, Data Modeling
Long Beach, California, United States · On-site
JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to the care management function, and contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the co…
Skills: Administrative Support, Case Management, Data Entry, Customer Service, Time Management
Long Beach, California, United States · On-site
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 …
Skills: Care Management, Care Coordination, Comprehensive Assessments, Motivational Interviewing, Medication Reconciliation
Long Beach, California, United States · On-site
$24/hr–$46/hr
JOB DESCRIPTION Opportunity for a Texas licensed LVN to join Molina as a Field Care Manager to work with our Medicare members in the service delivery area in the Northwest part of Houston. You will complete assessments n…
Skills: Care Management, Member Assessments, Care Planning, Case Coordination, Motivational Interviewing
Long Beach, California, United States · Remote OK
$49k–$107k/yr
JOB DESCRIPTION The Senior Specialist, Coding supports Payment Integrity Prepay operations by researching correct coding edit inquiries, analyzing edit outcomes, validating coding rationale, and monitoring savings and ac…
Skills: Medical Coding, Auditing, Compliance, Chart Review, HCC Model
Long Beach, California, United States · Remote OK
$16/hr–$35/hr
JOB DESCRIPTION Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases. Sync…
Skills: Provider Configuration, Data Validation, Critical Thinking, Attention To Detail, Time Management
Long Beach, California, United States · On-site
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 …
Skills: Care Management, Care Coordination, Comprehensive Assessments, Motivational Interviewing, Medication Reconciliation
Long Beach, California, United States · Remote OK
$17/hr–$30/hr
JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to the care management function, and contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the co…
Skills: Administrative Support, Case Assignment, Member Screening, Data Entry, Scheduling
Long Beach, California, United States · On-site
$25/hr–$51/hr
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 …
Skills: Care Management, Care Coordination, Comprehensive Assessments, Motivational Interviewing, Medication Reconciliation
Long Beach, California, United States · Remote Solely
JOB DESCRIPTION **Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday through Friday from 9:30 AM to 6:00 PM CST and requires prior experience in Utilization Management (UM) an…
Skills: Utilization Management, MCG Guidelines, Clinical Determinations, Prior Authorization, Medical Necessity Review
Long Beach, California, United States · Remote Solely
JOB DESCRIPTION **Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday through Friday from 8:30 AM to 5:30 PM CST and requires prior experience in Utilization Management (UM) an…
Skills: Utilization Management, MCG Guidelines, Clinical Review, Medical Necessity Assessment, Prior Authorization
Long Beach, California, United States · Remote OK
$14/hr–$29/hr
JOB DESCRIPTION Job Summary Provides support for member waiver coordination activities. Contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the continuum, and overarch…
Skills: Administrative Support, Waiver Coordination, Case Documentation, HIPAA Compliance, Problem Solving
Long Beach, California, United States · On-site
$16/hr–$31/hr
JOB DESCRIPTION Job SummaryProvides support for community-based member advocacy activities. Serves as a local member advocate and resource, using knowledge of the community and resources available to engage and assist vu…
Skills: Member Advocacy, Case Management, Community Outreach, Customer Service, Time Management
Long Beach, California, United States · On-site
JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports (LTSS)-specific activities. Collaborates with multidisciplinary team coordinating integrated delivery of …
Skills: Care Management, Care Coordination, Member Assessment, Care Planning, Waiver Enrollment
Long Beach, California, United States · Remote OK
$14/hr–$29/hr
JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to the care management function, and contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the co…
Skills: Administrative Support, Case Assignment, Member Screening, Data Entry, Scheduling
Long Beach, California, United States · Remote OK
$13/hr–$29/hr
JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to the care management function, and contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the co…
Skills: Administrative Support, Case Assignment, Data Entry, Member Screening, Scheduling
Long Beach, California, United States · On-site
$26/hr–$51/hr
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 …
Skills: Care Management, Care Coordination, Comprehensive Assessments, Motivational Interviewing, Medication Reconciliation
Long Beach, California, United States · Remote OK
$80k–$172k/yr
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. R…
Skills: Big Data Architecture, Databricks, Hadoop, Spark, Kafka
Long Beach, California, United States • Remote OK
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Leads complex contracting activities with strategically critical provider groups, including hospitals and IPAs, to ensure network adequacy and financial performance. Negotiates value-based payment models and manages the optimization of provider relationships and reimbursement structures.
Requires at least 5 years of network contracting experience with large provider groups and 3 years of managed health care negotiation experience. Must possess deep familiarity with Medicaid and Medicare compensation methodologies, including capitation and fee-for-service.
Remote and must live in Washington
Provides subject matter expertise and leadership for health plan provider network complex contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Responsible for negotiating agreements, including value-based payment methodology, with complex provider groups that are strategically critical to plan success, including but not limited to: hospitals, independent physician associations (IPAs), and behavioral health organizations.
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
Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care. Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.
Offices: 200 Oceangate, Long Beach, California 90802, US
Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care. Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.
Offices: 200 Oceangate, Long Beach, California 90802, US
