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Pharmacy Tech, Prior Auth CPhT or PTCB (Remote) at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Prior Authorization, Pharmacy Claims, Managed Care, Medical Necessity Review, Hipaa Compliance, Microsoft Excel, Written Communication, Verbal Communication, Pharmacy Benefit Management, Retail Pharmacy Experience
Specialization
Requires at least 2 years of pharmacy technician experience and a CPhT certification or state license. Candidates must be proficient in Microsoft Office and capable of navigating multiple computer systems simultaneously.
Experience Required
Minimum 2 year(s)
Care Manager (RN) Remote (Must reside in Arizona) at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Care Management, Case Management, Patient Assessment, Care Coordination, Motivational Interviewing, Medication Reconciliation, Electronic Medical Records, Hipaa Compliance, Time Management, Problem Solving, Critical Thinking, Interdisciplinary Collaboration, Microsoft Office, Patient Outreach, Behavioral Health Support, Clinical Judgment
Specialization
Requires a valid Registered Nurse (RN) license and at least 2 years of experience in healthcare, preferably in care management or behavioral health. Candidates must have a valid driver's license and the ability to travel locally within the service area.
Experience Required
Minimum 2 year(s)
RN/LPN Full-time Nightshift at Evoraa Healthcare
, Georgia, United States - Full Time
Skills Needed
Medication Administration, Vital Signs Monitoring, Patient Assessment, Client Admissions, Patient Discharge, Hipaa Compliance, Blood Draws, Tb Testing, Psychiatric Care, Chemical Dependency Treatment, Patient Observation, Clinical Documentation
Specialization
Candidates must hold a current unrestricted RN or LPN license in Georgia. Ability to work compassionately with individuals in psychiatric care or chemical dependency recovery is required.
Enrollment Representative - Intake at Orsini Healthcare
Elk Grove Village, Illinois, United States - Full Time
Skills Needed
Pharmacy Data Entry, Pharmacy Claims Processing, Insurance Eligibility Verification, Medical Insurance Knowledge, Multitasking, Written Communication, Verbal Communication, Attention To Detail, Typing Speed (40 Wpm)
Specialization
Requires over one year of experience in pharmacy data entry and claims resolution, along with a Pharmacy Technician License. Candidates must possess strong communication skills and the ability to type 40 WPM with accuracy.
Medical Director, Behavioral Health (FL) at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Behavioral Health Oversight, Clinical Leadership, Utilization Management, Care Management, Medical Necessity Review, Psychiatric Diagnosis, Peer Review, Quality Compliance, Clinical Practice Guidelines, Recruitment, Time Management, Critical Thinking, Problem Solving, Written Communication, Microsoft Office
Specialization
Requires an MD or DO with an active license and Board Certification in Psychiatry. Candidates must have at least 3 years of relevant experience, including 2 years of medical practice in psychiatry or behavioral health.
Experience Required
Minimum 2 year(s)
Licensed Primary Therapist LCSW, LMFT, LPC, or LPC-MHSP at Evoraa Healthcare
Brentwood, Tennessee, United States - Full Time
Skills Needed
Individual Therapy, Group Therapy, Family Therapy, Crisis Intervention, Psychosocial Assessments, Treatment Planning, Cbt, Dbt, Act, Family Systems, Addiction Counseling, Mental Health Diagnosis, Clinical Documentation, Kipu Emr, Microsoft Office, Cpr/First Aid
Specialization
Candidates must hold a Master's degree in counseling, social work, or psychology and possess an unrestricted license (LCSW, LMFT, LPC, or LPC-MHSP) in Tennessee. Experience with addictions, mental health diagnoses, and various counseling interventions like CBT and DBT is required.
Experience Required
Minimum 2 year(s)
Case Manager at Evoraa Healthcare
Brentwood, Tennessee, United States - Full Time
Skills Needed
Case Management, Patient Screening, Intake Assessment, Individualized Service Planning, Psychoeducational Instruction, Motivational Enhancement, Crisis Intervention, Resource Linking, Clinical Documentation, Interpersonal Skills, Analytical Skills, Customer Service, Joint Commission Standards, Dhs Standards, Regulatory Compliance, Patient Coordination
Specialization
A Bachelor's degree or equivalent experience is required, along with proven experience in case management and substance abuse or mental health services. Candidates should be detail-oriented and possess strong knowledge of Joint Commission and DHS standards.
Experience Required
Minimum 2 year(s)
Program Coordinator (Must Reside in Arizona) at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Administrative Support, Document Preparation, File Management, Scheduling, Travel Arrangement, Program Administration, Project Metrics Monitoring, Process Improvement, Budgeting, Statistical Reporting, Compliance Management, Liaison Communication
Specialization
Requires an associate degree or equivalent with 1-3 years of experience, though a bachelor's degree and 3-5 years are preferred. Candidates must reside in Arizona and possess skills in program coordination and regulatory compliance.
Experience Required
Minimum 2 year(s)
Primary Therapist at Evoraa Healthcare
Brentwood, Tennessee, United States - Full Time
Skills Needed
Individual Therapy, Group Therapy, Family Therapy, Crisis Intervention, Psychosocial Assessments, Treatment Planning, Cbt, Dbt, Act, Family Systems, Relapse Prevention, Clinical Documentation, Kipu Emr, Microsoft Office, Cpr/First Aid
Specialization
A Master's degree in counseling, social work, or psychology is required, along with experience in addictions and mental health. Candidates must be proficient in various counseling interventions like CBT and DBT and possess strong communication skills.
Experience Required
Minimum 2 year(s)
Advanced Practice Provider/Nurse Practitioner at Matter Healthcare
Memphis, Tennessee, United States - Full Time
Skills Needed
Primary Care, Preventive Care, Chronic Disease Management, Patient Panel Management, Telehealth, Ehr Documentation, Care Coordination, Geriatric Care, Value Based Care, Clinical Autonomy, Patient Centered Care, Medical Coding
Specialization
Requires an active Nurse Practitioner or Physician Associate license, board certification, and at least 3 years of clinical experience, preferably with aging populations. Must possess a valid driver's license, BLS certification, and proficiency in EHR documentation.
Experience Required
Minimum 2 year(s)
RN/LPN PRN Nightshift at Evoraa Healthcare
, Georgia, United States - Full Time
Skills Needed
Medication Administration, Vital Signs Monitoring, Patient Assessment, Client Admissions, Patient Discharge, Hipaa Compliance, Blood Draws, Tb Testing, Psychiatric Care, Chemical Dependency Treatment
Specialization
Candidates must hold a current unrestricted nursing license in Georgia. Experience in mental health or chemical dependency treatment is preferred, along with the ability to communicate effectively and compassionately.
Field Care Manager, LTSS (LVN) - Local Travel Required at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Care Management, Member Assessments, Care Planning, Case Coordination, Motivational Interviewing, Microsoft Office Suite, Clinical Documentation, Interdisciplinary Team Collaboration, Waiver Enrollment, Medical Necessity Assessment, Time Management, Problem Solving
Specialization
Requires a valid LVN/LPN license and at least 2 years of healthcare experience, including 1 year in LTSS and 1 year in care management. Must possess a valid driver's license and proficiency in Microsoft Office for documentation and reporting.
Experience Required
Minimum 2 year(s)
Peer Support Specialist at Evoraa Healthcare
Madison, Tennessee, United States - Full Time
Skills Needed
Peer Support, Assertive Engagement, Harm Reduction, Crisis Stabilization, Community Reintegration, Case Documentation, Trauma Informed Care, Patient Advocacy, Recovery Planning, Electronic Health Records
Specialization
Requires a Certified Peer Support Specialist (CPSS) certification or the ability to obtain it within 120 days of hire. Must be able to apply recovery-oriented principles and maintain professional boundaries.
Behavioral Health Technician 2nd Shift Full-time at Evoraa Healthcare
, Georgia, United States - Full Time
Skills Needed
De Escalation, Client Supervision, Crisis Management, Electronic Medical Records, Interpersonal Communication, Time Management, Emotional Support, Detail Oriented, Professional Judgment, Patient Safety
Specialization
Candidates should ideally be high school graduates or have a GED, with a preference for experience in mental health or substance abuse. A valid state driver's license and the ability to handle high-pressure situations are required.
Residential Behavioral Health Technician at Evoraa Healthcare
Norcross, Georgia, United States - Full Time
Skills Needed
Client Supervision, De Escalation, Crisis Management, Emotional Support, Electronic Medical Records, Interpersonal Communication, Time Management, Detail Oriented, Professional Boundaries, Patient Safety
Specialization
A high school diploma or GED is preferred, along with a valid state driver's license. Experience in substance abuse or mental health settings is preferred.
Medical Director (New York) at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Medical Oversight, Utilization Management, Medical Necessity Review, Clinical Quality Improvement, Regulatory Compliance, Case Management, Peer Review, Data Analytics, Problem Solving, Critical Thinking, Communication Skills, Microsoft Office
Specialization
Requires an active MD or DO license, board certification, and at least 3 years of healthcare experience. Candidates must possess strong organizational skills and knowledge of national and state healthcare laws.
Experience Required
Minimum 2 year(s)
Lead Analyst, Provider and Facility Reimbursement (Remote) at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Provider Reimbursement, Facility Reimbursement, Prospective Payment System (Pps), Microsoft Excel, Sql, Databricks, Data Analysis, Claims Adjudication, Managed Care, Cms Regulations, Value Based Pricing, Capitation, Bundled Payments, Project Management, Stakeholder Communication, Critical Thinking
Specialization
Requires at least 5 years of experience in complex provider reimbursement or claims adjudication within a managed care organization. Candidates must possess advanced Excel skills and the ability to interpret complex state and federal reimbursement policies.
Experience Required
Minimum 5 year(s)
Actuarial Consultant (Finance & Actuarial) - REMOTE at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Actuarial Analysis, Ibnr Estimation, Rate Adequacy Studies, Financial Reporting, Predictive Analytics, Statistics, Microsoft Excel, Problem Solving, Critical Thinking, Time Management, Verbal Communication, Written Communication
Specialization
Requires a bachelor's degree in a quantitative field and at least 5 years of actuarial experience with 4 passing SOA exams. Proficiency in statistics, predictive analytics, and Microsoft Office is essential.
Experience Required
Minimum 5 year(s)
Field Care Manager, LTSS (RN) - IDD Experience Required - Local Travel at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Care Management, Member Assessment, Care Planning, Case Coordination, Motivational Interviewing, Microsoft Office Suite, Medication Reconciliation, Interdisciplinary Care Team Facilitation, Waiver Enrollment, Clinical Documentation, Patient Advocacy, Time Management
Specialization
Requires a valid RN license and at least 2 years of healthcare experience, including 1 year in care management and 1 year working with persons with disabilities. Must possess a valid driver's license and proficiency in Microsoft Office Suite.
Experience Required
Minimum 2 year(s)
Care Manager, LTSS - Must live in OH at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Care Management, Care Coordination, Ltss, Member Assessment, Care Planning, Waiver Enrollment, Motivational Interviewing, Interdisciplinary Care Team Facilitation, Case Management, Community Resource Knowledge, Microsoft Office, Problem Solving, Time Management, Written Communication, Verbal Communication, Clinical Licensure
Specialization
Requires at least 2 years of healthcare experience, including 1 year in LTSS and 1 year in care management. A valid driver's license and reliable transportation are mandatory for field-based travel.
Experience Required
Minimum 2 year(s)
Pharmacy Tech, Prior Auth CPhT or PTCB (Remote) at Molina Healthcare
Long Beach, California, United States -
Full Time

Start Date

Immediate

Expiry Date

12 Oct, 26

Salary

0.0

Posted On

14 Jul, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Prior Authorization, Pharmacy Claims, Managed Care, Medical Necessity Review, HIPAA Compliance, Microsoft Excel, Written Communication, Verbal Communication, Pharmacy Benefit Management, Retail Pharmacy Experience

Industry

Hospitals and Health Care

Description
Molina Healthcare is hiring for a Pharmacy Technician who is State Licensed/Certified and/or PTCB certified. This role is 100% remote, and the hours will be Mon-Fri 10am to 630pm Pacific Standard Time.  This role will be reviewing prior authorization requests for medications to be reviewed by the RPh’s and or MD’s for determination, assisting in determining medical necessity for medications along with assisting with pharmacy claims.  Highly qualified candidates for this role will have the following experience- * 2+ years in a retail setting * Prior Authorization experience * Must be computer savvy- able to work within several computer systems at once * Managed care experience  * High level of communication skills, both written and verbal Essential Job Duties * Provides support for pharmacy technician activities. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. * Performs initial receipt and review of non-formulary or prior authorization requests against pharmacy plan approved criteria; requests additional information from providers as needed to properly evaluate requests. * Accurately enters approvals or denials of requests. * Facilitates prior authorization requests within established pharmacy policies and procedures. * Participates in the development/administration of pharmacy programs designed to enhance the utilization of targeted drugs and identification of cost-saving pharmacy practices. * Identifies and reports pharmacy departmental operational issues and resource needs to appropriate leadership. * Assists Molina member services, pharmacies, and health plan providers in resolving member prescription claims, prior authorizations, and pharmacy service access issues. * Articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed Required Qualifications * At least 2 years pharmacy technician experience, or equivalent combination of relevant education and experience. * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Ability to abide by Molina policies. * Ability to maintain attendance to support required quality and quantity of work. * Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA). * Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers. * Excellent verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software program(s) proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Key Words: Pharmacy Technician, Pharm Tech, Tech, National Certification, State License, Certification, Claims, Pharmacy Claims, Pharmacy, PBM, National Certified Pharmacy Technician (CPhT) certification, Medicaid, Medicare, Managed Care, MCO, Exchange, PBM, Pharmacy Benefit Management, Prior Auth
Responsibilities
Review prior authorization requests for medications to determine medical necessity and assist with pharmacy claims. Support pharmacy strategy to optimize healthcare outcomes and coordinate with providers and members to resolve prescription issues.
Pharmacy Tech, Prior Auth CPhT or PTCB (Remote) at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Prior Authorization, Pharmacy Claims, Managed Care, Medical Necessity Review, Hipaa Compliance, Microsoft Excel, Written Communication, Verbal Communication, Pharmacy Benefit Management, Retail Pharmacy Experience
Specialization
Requires at least 2 years of pharmacy technician experience and a CPhT certification or state license. Candidates must be proficient in Microsoft Office and capable of navigating multiple computer systems simultaneously.
Experience Required
Minimum 2 year(s)
Care Manager (RN) Remote (Must reside in Arizona) at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Care Management, Case Management, Patient Assessment, Care Coordination, Motivational Interviewing, Medication Reconciliation, Electronic Medical Records, Hipaa Compliance, Time Management, Problem Solving, Critical Thinking, Interdisciplinary Collaboration, Microsoft Office, Patient Outreach, Behavioral Health Support, Clinical Judgment
Specialization
Requires a valid Registered Nurse (RN) license and at least 2 years of experience in healthcare, preferably in care management or behavioral health. Candidates must have a valid driver's license and the ability to travel locally within the service area.
Experience Required
Minimum 2 year(s)
RN/LPN Full-time Nightshift at Evoraa Healthcare
, Georgia, United States - Full Time
Skills Needed
Medication Administration, Vital Signs Monitoring, Patient Assessment, Client Admissions, Patient Discharge, Hipaa Compliance, Blood Draws, Tb Testing, Psychiatric Care, Chemical Dependency Treatment, Patient Observation, Clinical Documentation
Specialization
Candidates must hold a current unrestricted RN or LPN license in Georgia. Ability to work compassionately with individuals in psychiatric care or chemical dependency recovery is required.
Enrollment Representative - Intake at Orsini Healthcare
Elk Grove Village, Illinois, United States - Full Time
Skills Needed
Pharmacy Data Entry, Pharmacy Claims Processing, Insurance Eligibility Verification, Medical Insurance Knowledge, Multitasking, Written Communication, Verbal Communication, Attention To Detail, Typing Speed (40 Wpm)
Specialization
Requires over one year of experience in pharmacy data entry and claims resolution, along with a Pharmacy Technician License. Candidates must possess strong communication skills and the ability to type 40 WPM with accuracy.
Medical Director, Behavioral Health (FL) at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Behavioral Health Oversight, Clinical Leadership, Utilization Management, Care Management, Medical Necessity Review, Psychiatric Diagnosis, Peer Review, Quality Compliance, Clinical Practice Guidelines, Recruitment, Time Management, Critical Thinking, Problem Solving, Written Communication, Microsoft Office
Specialization
Requires an MD or DO with an active license and Board Certification in Psychiatry. Candidates must have at least 3 years of relevant experience, including 2 years of medical practice in psychiatry or behavioral health.
Experience Required
Minimum 2 year(s)
Licensed Primary Therapist LCSW, LMFT, LPC, or LPC-MHSP at Evoraa Healthcare
Brentwood, Tennessee, United States - Full Time
Skills Needed
Individual Therapy, Group Therapy, Family Therapy, Crisis Intervention, Psychosocial Assessments, Treatment Planning, Cbt, Dbt, Act, Family Systems, Addiction Counseling, Mental Health Diagnosis, Clinical Documentation, Kipu Emr, Microsoft Office, Cpr/First Aid
Specialization
Candidates must hold a Master's degree in counseling, social work, or psychology and possess an unrestricted license (LCSW, LMFT, LPC, or LPC-MHSP) in Tennessee. Experience with addictions, mental health diagnoses, and various counseling interventions like CBT and DBT is required.
Experience Required
Minimum 2 year(s)
Case Manager at Evoraa Healthcare
Brentwood, Tennessee, United States - Full Time
Skills Needed
Case Management, Patient Screening, Intake Assessment, Individualized Service Planning, Psychoeducational Instruction, Motivational Enhancement, Crisis Intervention, Resource Linking, Clinical Documentation, Interpersonal Skills, Analytical Skills, Customer Service, Joint Commission Standards, Dhs Standards, Regulatory Compliance, Patient Coordination
Specialization
A Bachelor's degree or equivalent experience is required, along with proven experience in case management and substance abuse or mental health services. Candidates should be detail-oriented and possess strong knowledge of Joint Commission and DHS standards.
Experience Required
Minimum 2 year(s)
Program Coordinator (Must Reside in Arizona) at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Administrative Support, Document Preparation, File Management, Scheduling, Travel Arrangement, Program Administration, Project Metrics Monitoring, Process Improvement, Budgeting, Statistical Reporting, Compliance Management, Liaison Communication
Specialization
Requires an associate degree or equivalent with 1-3 years of experience, though a bachelor's degree and 3-5 years are preferred. Candidates must reside in Arizona and possess skills in program coordination and regulatory compliance.
Experience Required
Minimum 2 year(s)
Primary Therapist at Evoraa Healthcare
Brentwood, Tennessee, United States - Full Time
Skills Needed
Individual Therapy, Group Therapy, Family Therapy, Crisis Intervention, Psychosocial Assessments, Treatment Planning, Cbt, Dbt, Act, Family Systems, Relapse Prevention, Clinical Documentation, Kipu Emr, Microsoft Office, Cpr/First Aid
Specialization
A Master's degree in counseling, social work, or psychology is required, along with experience in addictions and mental health. Candidates must be proficient in various counseling interventions like CBT and DBT and possess strong communication skills.
Experience Required
Minimum 2 year(s)
Advanced Practice Provider/Nurse Practitioner at Matter Healthcare
Memphis, Tennessee, United States - Full Time
Skills Needed
Primary Care, Preventive Care, Chronic Disease Management, Patient Panel Management, Telehealth, Ehr Documentation, Care Coordination, Geriatric Care, Value Based Care, Clinical Autonomy, Patient Centered Care, Medical Coding
Specialization
Requires an active Nurse Practitioner or Physician Associate license, board certification, and at least 3 years of clinical experience, preferably with aging populations. Must possess a valid driver's license, BLS certification, and proficiency in EHR documentation.
Experience Required
Minimum 2 year(s)
RN/LPN PRN Nightshift at Evoraa Healthcare
, Georgia, United States - Full Time
Skills Needed
Medication Administration, Vital Signs Monitoring, Patient Assessment, Client Admissions, Patient Discharge, Hipaa Compliance, Blood Draws, Tb Testing, Psychiatric Care, Chemical Dependency Treatment
Specialization
Candidates must hold a current unrestricted nursing license in Georgia. Experience in mental health or chemical dependency treatment is preferred, along with the ability to communicate effectively and compassionately.
Field Care Manager, LTSS (LVN) - Local Travel Required at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Care Management, Member Assessments, Care Planning, Case Coordination, Motivational Interviewing, Microsoft Office Suite, Clinical Documentation, Interdisciplinary Team Collaboration, Waiver Enrollment, Medical Necessity Assessment, Time Management, Problem Solving
Specialization
Requires a valid LVN/LPN license and at least 2 years of healthcare experience, including 1 year in LTSS and 1 year in care management. Must possess a valid driver's license and proficiency in Microsoft Office for documentation and reporting.
Experience Required
Minimum 2 year(s)
Peer Support Specialist at Evoraa Healthcare
Madison, Tennessee, United States - Full Time
Skills Needed
Peer Support, Assertive Engagement, Harm Reduction, Crisis Stabilization, Community Reintegration, Case Documentation, Trauma Informed Care, Patient Advocacy, Recovery Planning, Electronic Health Records
Specialization
Requires a Certified Peer Support Specialist (CPSS) certification or the ability to obtain it within 120 days of hire. Must be able to apply recovery-oriented principles and maintain professional boundaries.
Behavioral Health Technician 2nd Shift Full-time at Evoraa Healthcare
, Georgia, United States - Full Time
Skills Needed
De Escalation, Client Supervision, Crisis Management, Electronic Medical Records, Interpersonal Communication, Time Management, Emotional Support, Detail Oriented, Professional Judgment, Patient Safety
Specialization
Candidates should ideally be high school graduates or have a GED, with a preference for experience in mental health or substance abuse. A valid state driver's license and the ability to handle high-pressure situations are required.
Residential Behavioral Health Technician at Evoraa Healthcare
Norcross, Georgia, United States - Full Time
Skills Needed
Client Supervision, De Escalation, Crisis Management, Emotional Support, Electronic Medical Records, Interpersonal Communication, Time Management, Detail Oriented, Professional Boundaries, Patient Safety
Specialization
A high school diploma or GED is preferred, along with a valid state driver's license. Experience in substance abuse or mental health settings is preferred.
Medical Director (New York) at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Medical Oversight, Utilization Management, Medical Necessity Review, Clinical Quality Improvement, Regulatory Compliance, Case Management, Peer Review, Data Analytics, Problem Solving, Critical Thinking, Communication Skills, Microsoft Office
Specialization
Requires an active MD or DO license, board certification, and at least 3 years of healthcare experience. Candidates must possess strong organizational skills and knowledge of national and state healthcare laws.
Experience Required
Minimum 2 year(s)
Lead Analyst, Provider and Facility Reimbursement (Remote) at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Provider Reimbursement, Facility Reimbursement, Prospective Payment System (Pps), Microsoft Excel, Sql, Databricks, Data Analysis, Claims Adjudication, Managed Care, Cms Regulations, Value Based Pricing, Capitation, Bundled Payments, Project Management, Stakeholder Communication, Critical Thinking
Specialization
Requires at least 5 years of experience in complex provider reimbursement or claims adjudication within a managed care organization. Candidates must possess advanced Excel skills and the ability to interpret complex state and federal reimbursement policies.
Experience Required
Minimum 5 year(s)
Actuarial Consultant (Finance & Actuarial) - REMOTE at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Actuarial Analysis, Ibnr Estimation, Rate Adequacy Studies, Financial Reporting, Predictive Analytics, Statistics, Microsoft Excel, Problem Solving, Critical Thinking, Time Management, Verbal Communication, Written Communication
Specialization
Requires a bachelor's degree in a quantitative field and at least 5 years of actuarial experience with 4 passing SOA exams. Proficiency in statistics, predictive analytics, and Microsoft Office is essential.
Experience Required
Minimum 5 year(s)
Field Care Manager, LTSS (RN) - IDD Experience Required - Local Travel at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Care Management, Member Assessment, Care Planning, Case Coordination, Motivational Interviewing, Microsoft Office Suite, Medication Reconciliation, Interdisciplinary Care Team Facilitation, Waiver Enrollment, Clinical Documentation, Patient Advocacy, Time Management
Specialization
Requires a valid RN license and at least 2 years of healthcare experience, including 1 year in care management and 1 year working with persons with disabilities. Must possess a valid driver's license and proficiency in Microsoft Office Suite.
Experience Required
Minimum 2 year(s)
Care Manager, LTSS - Must live in OH at Molina Healthcare
Long Beach, California, United States - Full Time
Skills Needed
Care Management, Care Coordination, Ltss, Member Assessment, Care Planning, Waiver Enrollment, Motivational Interviewing, Interdisciplinary Care Team Facilitation, Case Management, Community Resource Knowledge, Microsoft Office, Problem Solving, Time Management, Written Communication, Verbal Communication, Clinical Licensure
Specialization
Requires at least 2 years of healthcare experience, including 1 year in LTSS and 1 year in care management. A valid driver's license and reliable transportation are mandatory for field-based travel.
Experience Required
Minimum 2 year(s)