Molina Healthcare jobs in Cleveland, OH

A leading healthcare organization in Cleveland, Ohio, is seeking a supervisor for customer support to enhance experiences for Molina members and providers. The ideal candidate will have significant experience in call centers and supervisory roles. This position emphasizes compliance, effective communication, and exceptional service. A range of benefits and competitive pay is offered, with...

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 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...

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 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...

JOB DESCRIPTION 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 quality and...

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...

JOB DESCRIPTION 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...

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 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 Summary 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...

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 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 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+ Supervises...

JOB DESCRIPTION Job SummaryLeads and supervises a team supporting non-clinical healthcare services activities for care management, care review, utilization management, transitions of care, behavioral health, long-term services and supports (LTSS), and/or other program specific service support - ensuring members reach desired outcomes through integrated delivery of care across the continuum....

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 vulnerable members in managing health care needs. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Engages with...

**Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to financial and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for accurate and timely maintenance of Value...

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...

Job DescriptionJob SummaryResponsible for continuous quality improvements regarding member engagement and memberretention. Represents Member issues in areas involving member impact and engagement including:New Member Onboarding, member plan benefits education, and the development/maintenanceof Member Materials.Knowledge/Skills/Abilities* Conducts direct outreach to new Medicare members to provide...

JOB DESCRIPTIONOpportunity 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 fully...