Dir, Healthcare Services-advanced Imaging
3 weeks ago
Must be proficient in UMK2, QNXT and Pega platforms
Must be able to manage multiple health plans and lines of business, and hold familiarity with all state regulatory requirements that Molina is present in
Job Summary
Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
KNOWLEDGE/SKILLS/ABILITIES
Directs and oversees one of the following key Healthcare Services functions: case management/disease management/care transitions; utilization management (Position oversees PA authorizations and manages the inpatient certification review staff for initial, concurrent, or retrospective reviews); long-term supports and services; or nurse advice line.
Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care review and management.
Develops, performs, and promotes interdepartmental integration and collaboration to enhance clinical services.
Collaborates with and keeps the AVP or VP of Healthcare Services informed of operational issues, staffing, resources, system, and program needs and presents solution action plan for issues.
Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote standardized Molina enterprise-wide approach to Care Management programs.
Ensures monthly auditing is occurring with appropriate follow-up.
Engaged in clinical training activities and outcomes.
Develops and mentors HCS managers and supervisors.
This a full-time position.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree in Healthcare-related field (equivalent combination of education, experience and/or Nursing license will be considered in lieu of Bachelor's Degree).
Required Experience
7+ years managed healthcare experience with line management responsibility including clinical operations.
Experience working within applicable state, federal, and third-party regulations.
Required License, Certification, Association
If licensed, license must be active, unrestricted and in good standing.
Preferred Education
Master's Degree in Business, Healthcare, Social Work, or related field.
Preferred Experience
10+ years managed care experience.
Operational and process improvement experience.
Preferred License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
**Pay Range**: $79,607.91 - $172,483.8 / ANNUAL
- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
-
Dir, Healthcare Analytics
2 weeks ago
Long Beach, United States Molina Healthcare Full timeJob DescriptionJob Description Job Summary Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings....
-
Imaging Service Engineer
3 weeks ago
Long Beach, United States Renovo Solutions Full timeSummary An Imaging Service Engineer (ISE) performs and documents planned maintenance and repair of medical diagnostic imaging equipment and associated systems with under the supervision from service management to perform the required duties. The ISE must demonstrate a working knowledge of and ability to use the required test equipment and have the electronic...
-
Environmental Service Aide
1 week ago
Long Beach, United States CommonSpirit Health Full timeOverview: CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our...
-
Environmental Service Aide
2 weeks ago
Long Beach, United States CommonSpirit Health Full timeOverview: CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our...
-
Environmental Service Aide
2 weeks ago
LONG BEACH, United States CommonSpirit Health Full timeCommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities...
-
Environmental Service Aide
2 weeks ago
LONG BEACH, United States CommonSpirit Health Full timeCommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities...
-
Healthcare Member Services Specialist
3 weeks ago
Long Beach, United States Dental Health Services Full timeJob DescriptionJob DescriptionYou will contribute to the strength of our team approach to collaborative dental health.Do you value making an impact and doing meaningful work? Are you ready to be a difference-maker at an established independent Employee-Owned specialized healthcare company? If you enjoy working with a team of caring and dedicated people, this...
-
Analyst, Healthcare Analytics
6 days ago
Long Beach, United States Molina Healthcare Full timeJob Summary Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. KNOWLEDGE/SKILLS/ABILITIES Develop ad-hoc reports...
-
Analyst, Healthcare Analytics
3 days ago
Long Beach, United States Molina Healthcare Full timeJob DescriptionJOB DESCRIPTIONJob SummaryPerforms research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant...
-
Analyst, Healthcare Analytics
3 days ago
Long Beach, California, United States Molina Healthcare Full timeJob DescriptionJOB DESCRIPTIONJob SummaryPerforms research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant...
-
Director, Vendor Management
5 days ago
Long Beach, United States Molina Healthcare Full timeJob Summary The position will oversee and manage the Vendor Management team responsible of managing and coordinating the vendor activities between contracted entities and Molina Healthcare to support enrollment, claims, contact center, appeals and grievances, risk adjustment, medical records, quality, Provider and/or other functions under operations across...
-
Healthcare Data Analyst
2 days ago
Long Beach, United States Molina Healthcare Full timeJob DescriptionJOB DESCRIPTION****Employee for this role will work standard EST business hours******Job Summary Designs and implements processes and solutions associated with a wide variety of healthcare data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and...
-
Sr Analyst, Healthcare Analytics
4 weeks ago
Long Beach, California, United States Molina Healthcare Full timeJob DescriptionJOB DESCRIPTIONJob SummaryPerforms research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant...
-
Program Director, Imo
2 days ago
Long Beach, United States Molina Healthcare Full timeThe Program Director, PMO (Business Integration) will support program activity related to integration of a single merger and acquisition or implementations to further Molina’s growth, business success, and fiscal performance in the ever-changing healthcare environment. Focuses on process improvement, organizational change management, project management...
-
Epic Home Health
2 weeks ago
Daytona Beach, United States Resourcing HQ Full timePosition Overview: We are seeking a detail-oriented and motivated individual to join our team as an Epic HomeHealth Analyst. In this role, you will be responsible for supporting the configuration, testing, and optimization of the Epic HomeHealth module, which facilitates the management of home health services and patient care in a home setting. The...
-
Certified Nuclear Medicine
1 week ago
West Palm Beach, United States Cardiac Imaging, Inc. Full timeJoin the country’s leading Cardiac PET provider! Cardiac Imaging Inc. (CII) is looking for talented and ambitious professionals to join our dynamic team and improve patient outcomes across the nation. Despite heart disease being the leading cause of death in the US, most physicians and patients do not have access to the leading technology in Cardiology. At...
-
Engineer, Big Data
2 days ago
Long Beach, United States Molina Healthcare Full timeJob DescriptionJob Description Job Summary Responsible for collecting, storing, processing, and analyzing large sets of data. The primary focus will be on choosing optimal solutions to use for these purposes, then maintaining, implementing, and monitoring them. He/she will also be responsible to follow architecture and best practices used across the...
-
Breast Imaging Attending
1 week ago
Long Branch, United States Tandym Group Full timeA healthcare system in New Jersey is actively seeking a licensed Breast Imaging Attending to join their growing medical team in Monmouth County. Responsibilities: The Breast Imaging Attending will be responsible for: Supervising and interpreting various breast imaging studies, including mammograms, ultrasound, magnetic resonance imaging (MRI), and other...
-
Long Beach, United States Dental Health Services Full timeJob DescriptionJob DescriptionYou will contribute to the strength of our team approach to collaborative dental health.Do you value making an impact and doing meaningful work? Are you ready to be a difference-maker at an established independent Employee-Owned specialized healthcare company? If you enjoy working with a team of caring and dedicated people, this...
-
Long Beach, United States Molina Healthcare Full timeJob DescriptionJOB DESCRIPTIONJob Summary Molina Health Plan Dental Provider Network Management and Operations jobs are responsible for dental network development, dental network adequacy and dental provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant...