Molina Healthcare jobs in Sterling Heights, MI

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 requiredWork 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 support 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 DESCRIPTION Job SummaryProvides non-clinical administrative support to utilization management team and contributes to interdisciplinary 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* Provides telephone, clerical and data entry support for the care...

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 DESCRIPTION Job SummaryProvides senior level audit support for delegation oversight activities. Responsible for ensuring delegates are complaint with the applicable state, federal, contractual requirements, National Committee for Quality Assurance (NCQA), and Molina requirements for the health plan(s) they support. Identifies risk and non-compliance, issues corrective action, and actively...

JOB DESCRIPTION Job SummaryProvides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member...

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 DESCRIPTION Job 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 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 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 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 SummaryResponsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs...

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 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 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...