Molina Healthcare jobs in Cleveland, OH

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 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 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 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....

For this position we are seeking a (RN) Registered Nurse who must live and have a current active unrestricted RN license in the state of OHCase Manager RN will work in remote and field setting supporting Medicare and Medicaid l health population. This role will be supporting our HIDE-SNP population, completing face to face assessments, care plans, and providing education and support to our...

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 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 SummaryThe role is responsible for assisting in establishing premium rates and conducting financial analysis and reporting. A key responsibility of this role is supporting the Molina Marketplace ACA individual market pricing, forecasting, and accrual processes.Essential Job Duties- Supports the development of incurred but not reported (IBNR) estimates and rate adequacy studies,...

JOB DESCRIPTIONJob SummaryProvides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS).Essential Job Duties- Facilitates comprehensive research and resolution of...

Job DescriptionJob SummaryThe Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems.Knowledge/Skills/Abilities+ Facilitates the resolution of...

JOB DESCRIPTIONJob SummaryProvides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.Essential Job Duties- Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective...

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 members as...

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 members as...

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 members as...

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 members as...

Job DescriptionJob SummaryThis position will be responsible for supporting the execution of merger and acquisition transactions and will actively contribute in advancing Molina Healthcare's overall growth strategy. The role entails working closely with the senior members of the Corporate Development team and will actively interact with the business leaders and senior management team at Molina.The...

Job DescriptionJob SummaryWe are seeking an experienced and forward-thinking Senior AI Security Architect to join our newly formed AI Security Architecture team. In this critical role, you will be responsible for designing and implementing the security framework for our cutting-edge artificial intelligence and machine learning systems. You will be the subject matter expert for securing AI/ML...

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

Job DescriptionJob SummaryRespond to inbound calls to provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims.Knowledge/Skills/Abilities+ Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents...

Job DescriptionJob SummaryAs the Manager, Protection Services Operations Center (PSOC), you will be a member of Molina Healthcare's Protection Services Operations Center, reporting to the Director. This role is crisis and threat intelligence focused and includes responsibilities for ensuring the execution of the physical security controls, threat/risk analytics, and incident intake and crisis...