Molina Healthcare jobs in Guilderland, NY

JOB DESCRIPTION Job Summary The Care Manager RN 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. This position will...

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 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 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 Summary The Care Manager RN 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. This position will...

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 The Care Manager (RN) 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. This position...

Job Description Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, planning, and issue/risk management. Knowledge/Skills/Abilities - Ability to provide strategic leadership on projects while also managing multiple, complex challenging projects and...

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 Description Job Summary The Director of IT (Telecom) provides strategic and operational leadership for the organization’s enterprise communication, collaboration, and digital engagement ecosystem. This role oversees cloud-based technologies that power voice, video, messaging, digital identity, and contact center experiences—ensuring seamless, intelligent, and secure interactions for...

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 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 DescriptionWork hours will be 7am-3:30pm PST M-FJob SummaryResponsible for conducting various healthcare Healthcare claim audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains to...

Job DescriptionJob SummaryMolina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance 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...

JOB DESCRIPTION Job SummaryLeads and manages a team of medical directors delivering oversight and expertise in appropriateness and medical necessity of services provided to members - ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care.Essential Job Duties- Leads a team of medical...

JOB DESCRIPTIONJob SummaryThe Care Manager 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.This position will be...

Job SummaryReporting to the Director of Clinical Informatics for Analytics & Interfaces, the Clinical Informatics Data Analyst is responsible for the development, design, and maintenance of critical business reports based on data stored in multiple sources. This role will involve supporting the Care Connections team by extracting, validating, and analyzing data to measure and monitor department...

JOB DESCRIPTIONJob SummaryMolina Health Plan Provider Network Management and Operations 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 Services staff are the primary point of...