Long Beach, California, United States · On-site
$12/hr–$26/hr
JOB DESCRIPTION Job Summary Provides support for claims adjustment activities including administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit i…
Skills: Claims Adjustment, Data Entry, Research, Organizational Skills, Attention To Detail
Long Beach, California, United States · On-site
$23/hr–$51/hr
JOB DESCRIPTION This RN will act as a Care Review Clinician supporting our Medicare members. The position is fully remote. Excellent computer skills and attention to detail are very important to multitask between systems…
Skills: Clinical Review, Medical Necessity Verification, Utilization Management, Prior Authorization, Case Management
Long Beach, California, United States · Remote OK
$23/hr–$51/hr
JOB DESCRIPTION This RN will act as a Care Review Clinician and provide clinical review support for Medicare inpatient utilization management activities. Conducts medical necessity reviews of inpatient admissions and ong…
Skills: Case Management, Managed Care, Utilization Management, Clinical Review, Patient Assessment
Long Beach, California, United States · Remote OK
$23/hr–$51/hr
JOB DESCRIPTION This RN will act as a Care Review Clinician supporting our Medicaid members who have recently been admitted to this hospital. The Medicaid will support them to ensure a successful transition from inpatien…
Skills: Case Management, Managed Care, Utilization Management, Clinical Review, Prior Authorization
Long Beach, California, United States · Hybrid
$23/hr–$51/hr
JOB DESCRIPTION This RN will act as a Care Manager supporting our Medicaid, Medicare and Marketplace members who have recently been admitted to this hospital. The Medicaid will support them to ensure a successful transit…
Skills: Care Management, Case Management, Patient Assessment, Care Coordination, Motivational Interviewing
Long Beach, California, United States · On-site
JOB DESCRIPTION Job Summary Provides administrative support for Wisconsin IRIS program operations, including referrals, enrollment, eligibility, service authorization and other administrative related requirements of the …
Skills: Administrative Support, Customer Service, Data Entry, Analytical Skills, Problem Solving
Long Beach, California, United States · On-site
$14/hr–$26/hr
JOB DESCRIPTION Job Summary Must reside in Florida. Provides support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, …
Skills: Claims Examination, Claims Adjudication, Medical Coding, Fraud Detection, Data Entry
Long Beach, California, United States · On-site
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, Community Outreach, Case Management, 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 · Remote OK
$49k–$107k/yr
JOB DESCRIPTION Job Summary Provides senior level support for clinical quality member intervention activities. Responsible for the developing and implementing new and existing member intervention initiatives including al…
Skills: Data Analysis, HEDIS, NCQA, Business Writing, Problem Solving
Long Beach, California, United States · Remote OK
$26/hr–$56/hr
Job Description Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines…
Skills: Medical Review, Utilization Review, Medical Necessity, ICD-10, CPT Coding
Long Beach, California, United States · Remote OK
$49k–$107k/yr
JOB DESCRIPTION Job Summary Provides senior level support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes Uses a consultative approa…
Skills: Provider Engagement, Risk Adjustment, HEDIS Quality Scores, Value-Based Care, Data Analysis
Long Beach, California, United States · Remote OK
$66k–$143k/yr
JOB DESCRIPTION Job Summary Leads and manages team responsible for health plan provider engagement activities. Collaborates with senior leadership and the health plan network team to drive value-based care strategies, an…
Skills: Provider Engagement, Value-Based Care, Risk Adjustment, Quality Improvement, HEDIS/NCQA
Long Beach, California, United States · Remote OK
$49k–$107k/yr
JOB DESCRIPTION Job Summary Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databa…
Skills: Provider Configuration, Data Validation, Auditing, Compliance Reporting, Microsoft Excel
Long Beach, California, United States · Remote OK
JOB DESCRIPTION Job Summary Provides analyst support for workforce management activities including partnering with leaders to identify business needs, and proposing solutions in line with the needs of members and provide…
Skills: Workforce Management, Data Analysis, Capacity Modeling, Root-Cause Analysis, Critical Thinking
Long Beach, California, United States · On-site
$30/hr–$59/hr
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 memb…
Skills: Care Management, Care Coordination, Member Assessment, Care Planning, Motivational Interviewing
Long Beach, California, United States · Remote OK
$88k–$190k/yr
Job Description Job Description We are seeking a highly skilled GenAI / Agentic AI Engineer to design, build, and deploy autonomous, LLM-powered systems that solve complex business problems at scale. This role focuses on…
Skills: GenAI, Agentic AI, RAG, Python, LLMs
Long Beach, California, United States · Remote OK
Job Description Job Summary Provides support in conducting research, analysis, and reporting across healthcare and operational data to support decision‑making, cost‑containment strategies, and business performance improv…
Skills: Data Analysis, SQL, Excel, Business Intelligence Tools, Healthcare Analytics
Long Beach, California, United States · On-site
JOB DESCRIPTION Job Summary Provides level I support center customer service excellence to meet the needs of Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating M…
Skills: Customer Service, Call Center Operations, Data Processing, Time Management, HIPAA Compliance
Long Beach, California, United States · Remote OK
JOB DESCRIPTION This RN will act as a Care Review Clinician supporting our Medicaid members who have recently been admitted to this hospital. The Medicaid will support them to ensure a successful transition from inpatien…
Skills: Utilization Management, Case Management, Clinical Review, Patient Assessment, Prior Authorization
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Provides support for claims adjustment activities, including administering payments and maintaining records. Monitors workflow to ensure claims are settled timely and in accordance with cost-control standards.
Requires at least 1 year of clerical experience in claims or customer service, preferably in managed care. Proficiency in Microsoft Office and strong organizational and communication skills are necessary.
JOB DESCRIPTION Job Summary
Provides support for claims adjustment activities including administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Also monitors and controls backlog and workflow of claims, and ensures that claims are settled in a timely fashion and in accordance with cost-control standards.
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
