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
JOB DESCRIPTION Job Summary Responsible for leveraging the technology for the benefit of the business. Interface and manage strategic relationships with business partners by representing & promoting IM capabilities. KNOW…
Skills: Stakeholder Management, Business Relationship Management, IT Liaison, Project Triage, Demand Intake Management
Long Beach, California, United States · On-site
Job Description Job Summary Under general supervision, this position has lead responsibilities for accessing, integrating, data compilation, data management, data analysis, data quality controls and reporting from variou…
Skills: Data Management, SQL, Python, Perl, SAS
Long Beach, California, United States · Remote OK
$73k–$171k/yr
JOB DESCRIPTION Leads and manages team responsible for special investigation unit (SIU) activities, specifically the prevention and detection of violation of applicable laws and regulations. Responsible to protect the bu…
Skills: Special Investigations, Law Enforcement, Regulatory Compliance, Management, Analytical Thinking
Long Beach, California, United States · Remote OK
$19/hr–$42/hr
JOB DESCRIPTION Job Summary Provides support for provider denial coding dispute activities. Investigates and resolves disputes related to provider appeals, and ensures that claims adhere to correct billing standards and …
Skills: Medical Coding, Medical Billing, Claims Denial Management, Medical Record Review, Auditing
Long Beach, California, United States · Hybrid
JOB DESCRIPTION Job Summary This RN will act as a Transition of Care Coach supporting our Michigan Medicare and Dual members who have recently been admitted to this hospital. The TOC Coach will support them to ensure a s…
Skills: Case Management, Discharge Planning, Care Coordination, Motivational Interviewing, Patient Education
Long Beach, California, United States · Remote OK
$80k–$172k/yr
JOB DESCRIPTION Role Summary This role provides dedicated engineering ownership for Molina’s Secure Access Service Edge (SASE) platform and enterprise data protection capabilities, with supporting responsibility for endp…
Skills: SASE, Data Security, Zscaler, Microsoft Purview, DLP
Long Beach, California, United States · Remote OK
JOB DESCRIPTION Job Summary Provides senior level analyst support for finance activities including financial analysis, reporting, forecasting, trending and modeling to support planning for future business decisions such …
Skills: Financial Analysis, Financial Reporting, Forecasting, Budgeting, SQL
Long Beach, California, United States · On-site
$15/hr–$30/hr
Job Description Please note the required shifts are Mon - Fri 10:00 AM– 7:00 PM or Tues - Sat 7:00AM - 4:00PM Pacific Time Zone. Job Summary Makes outbound calls to members, completes assigned hand-dial lists, and provid…
Skills: Bilingual Spanish, Outbound Calling, Member Support, Appointment Scheduling, Healthcare Administration
Long Beach, California, United States · Remote OK
$23/hr–$51/hr
JOB DESCRIPTION This RN will act as a Care Review Clinician supporting our Medicare members who have recently been admitted to this hospital. The Medicare will support them to ensure a successful transition from inpatien…
Skills: Case Management, Managed Care, Inpatient Review, Prior Authorization, Clinical Assessment
Long Beach, California, United States · On-site
$45k–$89k/yr
JOB DESCRIPTION Job Summary Provides senior level support for government contracts activities. Responsible for the development and administration of contracts with state and/or federal governments for Medicaid, Medicare,…
Skills: Government Contracts Administration, Regulatory Compliance, Medicaid, Medicare, Marketplace Programs
Long Beach, California, United States · On-site
Job Summary 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 …
Skills: Provider Network Contracting, Value-Based Payment Methodology, Contract Negotiation, Managed Care, Financial Analysis
Long Beach, California, United States · On-site
JOB DESCRIPTION Job Summary Provides deep subject matter expertise and leadership for competitor analysis activities for Molina request for proposals (RFPs) for new or reprocuring business. Leads Molina competitive intel…
Skills: Competitive Intelligence, Market Analysis, RFP Management, Strategic Planning, Cross-functional Collaboration
Long Beach, California, United States · On-site
$49k–$107k/yr
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 entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in ac…
Skills: Claims Processing, Customer Service, Provider Service, Time Management, Verbal Communication
Long Beach, California, United States · On-site
JOB DESCRIPTION Job Summary Provides lead level analyst support for configuration information management activities. Responsible for accurate and timely implementation and maintenance of critical information on claims da…
Skills: Configuration Information Management, Networx Pricer, QNXT, Claims Processing, Data Analysis
Long Beach, California, United States · On-site
$20/hr–$40/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, Claims Processing, Critical Thinking, Attention To Detail
Long Beach, California, United States · On-site
$60k–$130k/yr
JOB DESCRIPTION Job Summary Provides senior level analyst support for advanced provider data management (PDM) activities including analyzing business processes related to PDM, identifying areas for improvement, and devel…
Skills: Business Analysis, SQL, Data Analysis, BRD Creation, FRD Creation
Long Beach, California, United States · Remote OK
JOB DESCRIPTION Job Summary Leads and supervises team responsible for payment integrity activities including recovery operations. Responsible for performance, quality levels and establishing procedures and techniques tha…
Skills: Payment Integrity, Recovery Operations, Claims Processing, Inventory Management, Quality Control
Long Beach, California, United States · Remote OK
JOB DESCRIPTION Job Summary Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, …
Skills: Project Management, Scrum Master, Process Improvement, Organizational Change Management, Risk Management
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Provides integrated care management and coordination for members by conducting comprehensive assessments and developing personalized care plans. Collaborates with multidisciplinary teams and performs outreach via telephonic or home visits to ensure quality, cost-effective member care.
Requires a valid, unrestricted Registered Nurse (RN) license and at least 2 years of experience in healthcare or care management. Must possess a valid driver's license and demonstrate proficiency in EMR systems and HIPAA regulations.
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 timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments.
• Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals.
• Conducts telephonic, face-to-face or home visits as required.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member caseload for regular outreach and management.
• Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
• Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
• May provide consultation, resources and recommendations to peers as needed.
• Care manager RNs may be assigned complex member cases and medication regimens.
• Care manager RNs may conduct medication reconciliation as needed.
• 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications
• At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA).
• Demonstrated knowledge of community resources.
• Ability to operate proactively and demonstrate detail-oriented work.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and self-motivation.
• Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving, and critical-thinking skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
Preferred Qualifications
• Experience closing care gaps (HEDIS measures, medication adherence, HOS surveys).
• Comfort using care management platforms and population health tools.
• Track record of successful member engagement and outreach.
• Understanding of CMS Star Ratings methodology and quality bonus payments.
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
