Molina Healthcare jobs in The Colony, 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 DescriptionJob SummaryThe 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...

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 DESCRIPTION Job SummaryProvides 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 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 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 DESCRIPTIONOpportunity for a TX licensed RN to join Molina to work with our Medicaid members in the greater Dallas service delivery area. Part of the responsibilities of the role is to conduct face-to-face meetings with the members in their homes, completing assessments needed for determining the types of services we need to provide. Preference will be given to those candidates with previous...

JOB DESCRIPTIONOpportunity for a Texas licensed LVN to join Molina as a Field Care Manager to work with our Medicaid members in the Dallas, TX serviced delivery area. You will complete assessments needed for determining the types of services the non-waiver members are eligible to receive. Preference will be given to those candidates with previous experience working with the Medicaid population...

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 SUMMARY - Lead Data EngineerA Lead Data Engineer collaborates with the Data Quality and Governance team to ensure data pipelines, data integrity, and compliance by defining data strategies, implementing Data Governance capabilities, creating self-service data assets, and integrating robust data quality and governance frameworks to support trustworthy AI solutions. Key responsibilities include...

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 DESCRIPTIONJob SummaryDesigns 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 people,...

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 DESCRIPTION Job Summary Molina 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...

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 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 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 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...