Molina Healthcare jobs in Alamo Heights, TX

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 continuum. Contributes to overarching strategy to provide quality and cost-effective member care.Essential Job Duties* This candidates would be working in an Inbound Call center...

JOB DESCRIPTION Opportunity for TX licensed RN to join our DSNIP team to work with our members who are hospitalized and ready to be discharged. The RN hired for this position will work with the hospital discharge team to make sure that all the appropriate resources, doctor appointments, etc. are ready so that the transition out of the facility occurs smoothly, At this time, this position is...

JOB DESCRIPTION Job Summary The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other standards and requirements pertaining...

JOB DESCRIPTION Job Summary Designs and builds company specific enterprise application systems and technology expertise across multiple disciplines. Applies and promotes key principles (e.g., stability, scalability, performance, security, compatibility, re-use), helping ensure a balance between tactical and strategic technology solutions. Considers business problems “end-to-end”: including...

For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high speed required Work Schedule Monday to Friday - operation hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides...

Job Description Job Summary The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. This position will be...

JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide...

JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Provides behavioral health oversight and...

JOB DESCRIPTION Opportunity for a TX licensed RN with experience working in women’s health; specifically, OB, L&D, or postpartum, to join our Texas Health Plan as a Case Manager. Your caseload will consist of members who are pregnant, many of them high risk. Telephonically you will complete assessments needed for determining the types of services we need to provide and managing their care until...

JOB DESCRIPTION Opportunity for a Texas licensed RN to join Molina to work with our Medicaid members in the San Antonio, TX service delivery areas. Part of the responsibilities of the role is to conduct face-to-face meetings with the members in their homes, completing assessments to determine the types of services we need to provide. Preference will be given to those candidates with previous...

JOB DESCRIPTION Opportunity for a Texas licensed RN to join Molina to work with our Medicaid members in the San Antonio, TX service delivery areas. Part of the responsibilities of the role is to conduct face-to-face meetings with the members in their homes, completing assessments to determine the types of services we need to provide. Preference will be given to those candidates with previous...

Job Description Responsible for overseeing data science projects, managing and mentoring a team, and aligning data initiatives with business goals. Lead the development and implementation of data models, collaborate with cross‑functional teams, and stay updated on industry trends. Ensure ethical data use and communicate complex technical concepts to non‑technical stakeholders. Lead initiatives...

Job DescriptionJob SummaryResponsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide.Knowledge/Skills/Abilities+ Conduct interviews with staff and management to assess internal business processes within a department...

Job DescriptionJob SummaryInterfaces with internal and external customers in reviewing scope and developing requirements and plans for testing / quality assurance for enterprise projects of considerable complexity. Works with cross functional teams to prepare comprehensive test design specifications for functional, regression, performance and security testing. Performs analysis to identify...

Job DescriptionJob SummaryMolina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between...

Job DescriptionJob SummaryThe Director of Cyber Recovery will oversee and manage Disaster Recovery related to the Information Technology (IT) organization's technology services to all customers working closely with the Network Operating Center (NOC) and Enterprise Business Continuity Management (EBCM) Team. This role is primarily responsible for Cyber Recovery activities supporting the overall...

JOB DESCRIPTIONJob SummaryProvides 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...

JOB DESCRIPTIONJob SummaryProvides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and...

Job DescriptionJob SummarySr. Analyst, Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality care with improved outcomes through better coordination and preventive care and develop payment strategies that...

Job DescriptionJob SummaryResponsible 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.Knowledge/Skills/Abilities- Convert concepts to technical architecture, design and implementation- Provide guidance on choosing ideal Architecture, Evaluating tools...