20 Best molina healthcare jobs (Hiring Now!)

Specialist, Appeals & Grievances (Remote: CST or EST)
Molina Healthcare —Columbus, OH3.3
Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine…
$16.40 - $31.97 an hour
Supv, Member Services (Medicaid)
Molina Healthcare —Long Beach, CA3.3
Demonstrates personal responsibility and accountability and leads by example through individual performance. Ensures compliance with Contractual and Regulatory…
$41,264 - $80,464 a year
7d
Case Management Processor - REMOTE
Molina Healthcare —Long Beach, CA3.3
Provides telephone, clerical, and data entry support for the Case Management team. HCS staff work to ensure that patients progress toward desired outcomes with…
$31,002 - $60,455 a year
3d
Provider Services Representative
Molina Healthcare —San Diego, CA3.3
Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan.
$19.84 - $38.69 an hour
7d
Medical Assistant - Corp (Bilingual English/Spanish) Remote
Molina Healthcare —Long Beach, CA3.3
A basic understanding of patient care, medical terminology, coding procedures, reference tools, and appropriate clinical pharmacology for medical assistant…
$14.17 - $27.62 an hour
13d
Care Review Processor - PST Hours, Including Weekends - Night Shifts (4 10)
Molina Healthcare —Long Beach, CA3.3
Provides telephone, clerical, and data entry support for the Care Review team. HCS staff work to ensure that patients progress toward desired outcomes with…
$13.55 - $26.42 an hour
Care Review Processor PST Hours, Including Weekends - Day Shift (4 10)
Molina Healthcare —Long Beach, CA3.3
Provides telephone, clerical, and data entry support for the Care Review team. HCS staff work to ensure that patients progress toward desired outcomes with…
$13.55 - $26.42 an hour
Care Review Processor - PST Hours, Including Weekends - Rotating Evening and Overnight Shifts
Molina Healthcare —Long Beach, CA3.3
Provides telephone, clerical, and data entry support for the Care Review team. HCS staff work to ensure that patients progress toward desired outcomes with…
$13.55 - $26.42 an hour
Provider Services Representative - Remote TX (Tarrant area)
Molina Healthcare —Fort Worth, TX3.3
Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health Plan.
$19.84 - $38.69 an hour
Lead Generalist, Medicare Administration
Molina Healthcare —Long Beach, CA3.3
7+ years of experience in the managed healthcare industry in a health plan or related field with MMP - Medicare-Medicaid plans.
$60,415 - $117,809 a year
4h
Supervisor, Healthcare Services - JFS
Molina Healthcare —Milwaukee, WI3.3
Active, unrestricted, Healthcare Related license in California if applicable. Works with physicians and multidisciplinary team members to develop a plan of care…
4h
RN Care Review Clinician Prior Authorization - WA
Molina Healthcare —Bothell, WA3.3
Active, unrestricted State Registered Nursing (RN) license in good standing. Assesses services for members to ensure optimum outcomes, cost effectiveness and…
$49,930 - $97,363 a year
Care Review Processor
Molina Healthcare —Long Beach, CA3.3
Provides telephone, clerical, and data entry support for the Care Review team. HCS staff work to ensure that patients progress toward desired outcomes with…
$13.55 - $26.42 an hour
Provider Contracts Manager
Molina Healthcare —Indianapolis, IN3.3
Bachelor's Degree in a healthcare related field or an equivalent combination of education and experience. Assists with cost control strategies that positively…
$66,456 - $129,590 a year
5d
RN Care Review Clinician Inpatient Review
Molina Healthcare —Long Beach, CA3.3
Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
$54,922 - $107,099 a year
4h
Care Review Processor - PST Hours, Including Weekends, Mid Shift (4 10)
Molina Healthcare —Long Beach, CA3.3
Provides telephone, clerical, and data entry support for the Care Review team. HCS staff work to ensure that patients progress toward desired outcomes with…
$13.55 - $26.42 an hour
Sr Business Analyst (Remote)
Molina Healthcare —Omaha, NE3.3
Actively participates in all stages of project development including research, design, programming, testing and implementation to ensures the released product…
$54,922 - $107,099 a year
3d
RN Care Review Clinician Inpatient Review
Molina Healthcare —Long Beach, CA3.3
Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
$54,922 - $107,099 a year
4h
Case Management Processor
Molina Healthcare —Long Beach, CA3.3
Provides telephone, clerical, and data entry support for the Case Management team. HCS staff work to ensure that patients progress toward desired outcomes with…
$14.90 - $29.06 an hour
4h
Case Management Processor - REMOTE - IA ONLY
Molina Healthcare —Des Moines, IA3.3
Provides telephone, clerical, and data entry support for the Case Management team. HCS staff work to ensure that patients progress toward desired outcomes with…
$31,002 - $60,455 a year

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Specialist, Appeals & Grievances (Remote: CST or EST)

Molina Healthcare - 3.3 Columbus, OH

Apply Now

Job Details

Full-time $16.40 - $31.97 an hour

Benefits

Health insurance

Qualifications

Medicare
Managed care
High school diploma or GED
2 years
Communication skills

Full Job Description

JOB DESCRIPTION

Job Summary

Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid

KNOWLEDGE/SKILLS/ABILITIES

Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Molina members, providers and related outside agencies to ensure that internal and/or regulatory timelines are met.

Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.

Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina Healthcare guidelines.

Responsible for meeting production standards set by the department.

Apply contract language, benefits, and review of covered services

Responsible for contacting the member/provider through written and verbal communication.

Prepares appeal summaries, correspondence, and document findings. Include information on trends if requested.

Composes all correspondence and appeal/dispute and or grievances information concisely and accurately, in accordance with regulatory requirements.

Research claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.

Resolves and prepares written response to incoming provider reconsideration request is relating to claims payment and requests for claim adjustments or to requests from outside agencies

JOB QUALIFICATIONS

REQUIRED EDUCATION:
High School Diploma or equivalency

REQUIRED EXPERIENCE:
Min. 2 years operational managed care experience (call center, appeals or claims environment).

Health claims processing background, including coordination of benefits, subrogation, and eligibility criteria.

Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials.

Strong verbal and written communication skills

Pay Range: $16.40 - $31.97 hourly*

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Apply Now

molina healthcare jobs

Specialist, Appeals & Grievances (Remote: CST or EST)

Supv, Member Services (Medicaid)

Case Management Processor - REMOTE

Provider Services Representative

Medical Assistant - Corp (Bilingual English/Spanish) Remote

Care Review Processor - PST Hours, Including Weekends - Night Shifts (4 10)

Care Review Processor PST Hours, Including Weekends - Day Shift (4 10)

Care Review Processor - PST Hours, Including Weekends - Rotating Evening and Overnight Shifts

Provider Services Representative - Remote TX (Tarrant area)

Lead Generalist, Medicare Administration

Supervisor, Healthcare Services - JFS

RN Care Review Clinician Prior Authorization - WA

Care Review Processor

Provider Contracts Manager

RN Care Review Clinician Inpatient Review

Care Review Processor - PST Hours, Including Weekends, Mid Shift (4 10)

Sr Business Analyst (Remote)

RN Care Review Clinician Inpatient Review

Case Management Processor

Case Management Processor - REMOTE - IA ONLY

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