JOB DESCRIPTION Job Summary This position will be remote, but candidate will need to be local to Washington state and support PST hours. Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: utilization management, behavioral health, care transitions, and/or special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Oversees team performance for one or more of the following healthcare services functions: utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), behavioral health, and/or special programs. • Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model. • Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care coordination and management. • Develops and promotes interdepartmental integration and collaboration to enhance clinical services. • May function as a “hands-on” leader - assisting with assessing and evaluation of systems, day-to-day operations and efficiency of services/care delivery. • Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators. • Assists in implementing utilization management, behavioral health, care transitions, and other program activities in accordance with regulatory, contract standards and accreditation compliance. • Ensures delivery of member care and services are aligned with Molina's established standards of customer service excellence. • Ensures high-risk, complex members are adequately supported. • Oversees ongoing monitoring of performance, protocols and guidelines related to healthcare services. • Collaborates with and keeps senior level healthcare services leadership apprised of operational issues, staffing, resources, system and program needs, and presents solutions/action plans for remediation. • Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care. • Oversees interdisciplinary care team (ICT) meetings. • Analyzes and reports on care access and monitoring statistics including plan utilization, staff productivity, cost-effective utilization of services, management of targeted member population, and triage activities. • Ensures completion of staff quality audit reviews evaluates services provided, outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost-effectiveness and compliance with all state and federal regulations and guidelines. • Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote a standardized enterprise-wide approach to healthcare services programs. • Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate. • Identifies opportunities for care delivery/quality/operational/etc. process improvements. • Hires, trains, develops and manages team demonstrates accountability for team performance and achievement of department-specific goals. • Local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 8 years of health care experience, including at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or special programs, or equivalent combination of relevant education and experience, or equivalent combination of relevant education and experience. • At least 3 years of management/leadership experience. • Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. • Strong customer service skills/member-centric focus. • Ability to work within a variety of settings and adjust style as needed, including ability to work with diverse populations, various personalities and personal situations. • Ability to prioritize and manage multiple deadlines. • Strong organizational and problem-solving skills. • Ability to collaborate cross-functionally within a highly matrixed organization. • Excellent written and verbal communication skills. • Microsoft Office suite and applicable software program(s) proficiency. Preferred Qualifications • Clinical experience. • Registered Nurse (RN) or master's level behavioral health (BH) licensure. License must be active and unrestricted in state of practice. • Medicaid/Medicare population experience. 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 Pay Range: $88,453 - $198,356 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job Summary Provides support for pre service appeals for members across all states throughout the organization, communicating with members and providers 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 appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. • Researches claims appeals and grievances using support systems to determine appropriate appeals 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 guidelines. • Meets claims production standards set by the department. • Applies contract language, benefits and review of covered services to claims review process. • Contacts members/providers as needed via written and verbal communications. • Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). • Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. • Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. • Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. Required Qualifications • At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. • Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. • Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. • Customer service experience. • Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. • Effective verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Experience with appeals for Medicare and Medicaid and the regulations with CMS. • Experience with pre authorization appeals. • Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). • Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. 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. Pay Range: $14.76 - $31.97 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job Summary Provides senior level support for coding activities. Monitors adherence to Molina's compliance program, minimizing risks related to coding and billing practices, and protecting the business from liability related to fraudulent/abusive practices. Performs chart reviews, facilitates physician education, and maintains comprehensive knowledge of coding rules and regulations. Essential Job Duties Performs ongoing chart reviews and abstracts diagnosis codes. Leverages understanding of current provider billing practices to ensure that diagnosis and Current Procedural Terminology (CPT) codes are submitted accurately. Coordinates with clinical informatics on system errors and suggests improvements to ensure effective and efficient processes are followed. Conducts coding reviews and audits to ensure accuracy and compliance. Researches and resolves coding discrepancies. Investigates and resolves rejected or denied claims or encounters. Maintains proficiency in EMR systems. Documents results/findings from chart reviews and provides feedback to leadership, providers, and office staff. Creates necessary tools (educational materials, newsletters, etc.) for providers to assist in current and accurate coding practices. Provides training and education to network of providers on risk adjustment best practices and provides coding updates related to risk adjustment. Monitors progress of providers to ensure guidelines set forth by Centers for Medicare and Medicaid Services (CMS) are adhered to. Builds positive relationships between providers and provides coding assistance as needed. Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education. Collaborates with cross-functional teams to support a variety of projects such as implementation of risk adjustment applications, development of reports, etc. Coordinates related activities with departments including finance, revenue analytics, claims, encounters, and medical directors. Coordinates CMS data validation activities, including record selection, tracking and submission, in conjunction with coding leadership. Maintains professional and technical coding-related knowledge. Maintains knowledge of updated coding guidance from recognized medical coding organizations. Provides training and support to new and existing coding team members. Required Job Qualifications At least 4 years of medical coding, auditing, and/or compliance experience, or equivalent combination of relevant education and experience. Certified Professional Coder (CPC) or Certified Coding Specialist (CCS). Detail-oriented skilled in medical/clinical documentation review. Ability to collaborate in a cross-functional highly matrixed organization. Ability to develop feedback and training tools. Ability to present educational materials to relevant groups. Effective verbal and written communication skills, including ability to present to medical professionals. Microsoft Office suite and applicable software program(s) proficiency. Preferred Job Qualifications • Familiar with the Hierarchical Condition Categories (HCC) risk adjustment model. • Background in supporting risk adjustment management activities and clinical informatics. 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 Pay Range: $49,430.25 - $107,098.87 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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 quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes clinical service requests from members or providers against evidence based clinical guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. • Processes requests within required timelines. • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote the Molina care model. • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified Professional in Healthcare Management (CPHM). • Recent hospital experience in an intensive care unit (ICU) or emergency room. 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 Pay Range: $23.76 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Description Job Summary Provides senior level support for special investigation unit (SIU) activities. Responsible for supporting for the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse (FWA). Responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care, and recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. Essential Job Duties • Responds to allegations of potential fraud, waste and abuse (FWA); conducts the investigation of fraudulent, wasteful and abusive activities involving members and providers. • Analyzes enrollment data, medical claims data, contract terms, financial records, provider and member claims history, and other documentation to determine FWA and identify potential patterns. • Applies regulatory and contractual requirements as well as internal policies and procedures to the case investigation process. • Perform data analysis, research and review of claims data to identify trends, patterns, outliers and emerging issues in health care FWA with fraud technology. • Conducts investigations and interviews to gather additional evidence. • Researches and investigates member identity theft cases through internal Alertline. • Communicates with members and providers routinely regarding issues including investigative findings, recoveries, and educational feedback where appropriate. • Compiles, reports and presents case information to the appropriate Medicaid fraud control unit or other regulatory agency. • Maintains the integrity of documentation for FWA cases; updates the case management system to ensure documentation of all calls, evidence, referrals, inquiries and case events are accurate for record keeping purposes and for “discovery” in court related cases. • Establishes and maintains strong relationships with external agencies including the Department of Health and Human Services (DHHS), Office of Inspector General (OIG), Drug Enforcement Administration (DEA), state professional licensing boards, US Attorney's office and state/local law enforcement agencies. • Prepares data requests from external law enforcement agencies as required. • Travels to conduct provider onsite audits and investigations. • Writes clear and concise reports, presents findings to providers and participates in negotiated resolution of issues at the direction of management. Tracks and reports any overpayment as a result of an investigation. • Uses findings to determine where there is a need for a change in policy and course of appropriate action based on line of business, severity of issue, regulatory compliance requirements and plan exposure. • Vets new concepts for building additional investigation opportunities/clearer review guidelines for cases. • Assist SIU leadership in case review and resolution. • Provides guidance to investigators as needed on investigative techniques, tools, or strategy. • Effectively investigates and manages complex and non-complex fraud allegations. • Develops and maintains relationships with key business units within specific product line and geographic region. • Provides direction, instructions and guidance to Investigative team, particularly in the absence of SIU leadership. • Creates, edits, and updates assigned reports to apprise the company on the team's progress. • Provides training and support to new and existing SIU team members. Required Qualifications • At least 3 years investigative experience in the health care industry, or equivalent combination of relevant education and experience. • Valid and unrestricted driver’s license. • Proven investigatory skills including ability to organize, analyze, and effectively determine risk with corresponding solutions, and remain objective and separate facts from opinions. • Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations. • Knowledge of managed care and Medicaid, Medicare, and Marketplace programs. • Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems. • Understanding of datamining and use of data analytics to detect FWA. • Ability to research and interpret regulatory requirements. • Effective interpersonal skills and customer service focus ability to interact with individuals at all levels. • Strong presentation skills with ability to create and deliver training, informational and other types of programs. • Strong logical, analytical, critical-thinking and problem-solving skills. • Strong sense of initiative, excellent follow-through, and persistence in locating and securing needed information.• Fundamental understanding of audits and corrective actions. • Ability to multi-task and operate effectively across geographic and functional boundaries. • Detail-oriented, self-motivated, and able to meet tight deadlines. • Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities. • Energetic and forward-thinking with high ethical standards and a professional image. • Collaborative and team-oriented. • Effective verbal and written communication skills. • Microsoft Office suite (Word, Excel, PowerPoint, Outlook), SharePoint, Intranet/Internet, and applicable software program(s) proficiency, and ability and experience incorporating/merging documents from various applications. Preferred Qualifications • Accredited Health Care Fraud Examiner (AHFI) and/or Certified Fraud Examiner (CFE). 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 Pay Range: $52,176 - $107,098.87 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Home Health Care, Hospice Care, Palliative Care, Long Term Care, Rehab No weekends, No afterhours support, No holidays Job Description Job Summary Are you seeking a unique nursing position that gives you a great work/life balance and lets you support people to live the lives that they choose? Then you’ll want to keep reading about this rewarding work opportunity! We are currently looking for a Registered Nurse licensed in Wisconsin to become our next IRIS Self-Directed Personal Care (SDPC) RN. This is a remote position, where you will partner with people in your community who are enrolled in the Wisconsin IRIS program – a Medicaid long-term care option for older adults and people with disabilities. People in the IRIS program who need personal care services have the choice to enroll in the IRIS Self-Directed Personal Care (IRIS SPDC) option. You can learn more about IRIS SDPC on the Wisconsin Department of Health Services website here , and learn about the IRIS program here . While this role is home-based, you will have regularly scheduled visits with people in their homes and communities. As an IRIS SDPC RN, you’ll provide oversight and guidance to the people enrolled in the IRIS SDPC option. You’ll also build relationships with the people you partner with and ensure that they’re getting the most out of the IRIS Self-Directed Personal Care option through assessment, oversight, training and education. IRIS SDPC RNs are responsible for administering the Wisconsin Personal Care Screening Tool; creating person-centered plans of care; providing personal care oversight to a group of people in IRIS, providing education and training for IRIS participants and care providers, and conducting the required documentation and follow-up. As an IRIS SDPC RN, you’ll play an important role in helping people of various backgrounds and abilities live their lives the way they choose. Knowledge/Skills/Abilities Provides personal care assessments and oversight to the My Cares Groups by administering the Wisconsin Personal Care Screening Tool and addendums as required Documents assessment as required by individual tool and Department of Health Services policies and by completing oversight visits and calls as required Oversees a My Cares Groups of participants, develops individual plans of care, ensures physician orders for care are obtained and reviews and revises plan of care as needed Submits for Prior Authorization for personal care services Complies with all Department of Health Services policies and SDPC Guidelines, procedures, and practices along with documentation and program regulations Provides personal care training to participants or care providers as requested and provides educational materials as needed Completes collateral contacts with IRIS Consultants and Long-Term Care Functional Screeners and physicians to ensure care needs are met Completes other duties as assigned Overtime work may be required May be required to drive 50% of the time during a given day of member home visits Exposure to members homes which may include navigating stairs, exposure to different environments, and pets Required Qualifications • At least 2 years nursing experience, and at least 1 year of experience serving the target groups of the IRIS program (adults with physical/intellectual disabilities or older adults), or equivalent combination of relevant education and experience. • Active and unrestricted Registered Nurse (RN) license in the state of Wisconsin. • Associate's degree in nursing. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements unless otherwise required by law. • Database operation/maintenance skills and data entry experience. • Teaching and mentoring skills. • Analytical and problem-solving skills. • Strong organizational and time-management skills, and ability to manage tasks independently. • Flexibility in the work environment, and willingness and ability to adapt to changing organizational needs. • Strong written and verbal communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Experience providing care through the Wisconsin Medical Assistance Personal Care program (MPAC). • Home care/home health experience. 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 Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long-term health care needs? Then TMG wants to hear from you! We’re currently looking for someone with a social services or human services background to join our team. This is a remote position, where you will partner with people in your community who are enrolled in the Wisconsin IRIS Program and the TMG IRIS Consultant Agency. While your office will be home-based, you will have regularly scheduled visits with IRIS participants in their home and community. As an IRIS Consultant (IC), you will build relationships with the people you partner with and help them navigate and get the most out of the Wisconsin IRIS program – a Medicaid long-term care option for older adults and people with disabilities. You can learn more about the IRIS program on the Wisconsin Department of Health Services website here . Together, you will identify the long-term care goals of the people enrolled in IRIS, and find creative ways to achieve those goals. ICs play an important role in helping people of various backgrounds and abilities live the lives that they choose. In fact, people constantly tell us how supportive our ICs are and what a positive impact our ICs have had on their lives! Successful candidates for this position will be compassionate, genuine, resourceful partners with an eye for high quality work, and who are excited to work side-by side with people enrolled in IRIS. As an IC, you will connect people to the resources available in their community. You will also help them develop customized IRIS plans for achieving their goals related to employment, housing, health, safety, community membership, transportation, and lasting relationships. While you will have a routine for the work that you do, no two days are alike! TMG wants to find the best possible candidates, so we created this Realistic Job Preview to provide you with an inside look at the position and our organization. Find out more about the IRIS Consultant position by clicking on the link and then reviewing the job posting below. TMG is committed to maintaining a diverse and inclusive workforce and prioritizes helping staff have a good work/life balance. Even though the position is remote, you’ll have lots of support from your TMG team and coworkers across the organization. If this sounds like the job for you, apply today! KNOWLEDGE/SKILLS/ABILITIES Required to meet in person with the IRIS participant a minimum of four times per year, with one required annual visit in the home of the participant. Because IRIS is a self-directed program, it is important for ICs to be available upon the request of the participant. Responsible for providing program orientation to new participants. During this time, participants will learn their rights and responsibilities as someone enrolled in the IRIS program, including verifying legal documents, completing employee paperwork and the responsible use of public dollars. Explore a broad view of the participant's life, including goals, important relationships, connections with the local community, interest in employment, awareness of the Self-Directed Personal Care option, and back-up support plans. Assist participants in identifying personal outcomes and ensure those outcomes are being met on an ongoing basis, all while staying within the participant's IRIS budget and within the requirements of the IRIS program determined by the Department of Health Services (DHS). Responsible for documenting all orientation and planning activities within the IRIS data system (WISITs) within 48 business hours of the visit with the participant. Research community resources and natural supports that will fit the individual outcomes for each participant and share that information with them as it becomes available. Responsible for documenting progress and changes as needed within the plan and the data system anytime a modification is requested by a participant. Budget Amendment or One-Time Expense paperwork may be required depending upon factors associated with the participant and their individual IRIS budget. Educate participants on how to read and interpret their monthly budget reports to ensure that participants operate within their budget. Being a liaison between the Fiscal Employer Agency and the IRIS Consultant Agency is also a large part of the position, which includes assisting participants with provider billing, seeking support brokers, tracking receipts, ensuring their workers are paid and mitigating areas of potential risk or conflicts of interest. Responsible to develop engaged and trusting relationships with participants and communicate program changes and compliance effectively. Responsible to maintain confidentiality and HIPPA compliance. Work collaboratively with other IRIS Consultant Agency staff in order to ensure a successful implementation of participants' plans. Attend in-person monthly team meetings with other ICs and their supervisor. In addition, weekly IC and IRIS Consultant Supervisor phone check-ins may occur, along with other duties as assigned. Required Qualifications • At least 2 years experience in health care, preferably in care coordination, and at least 1 year of experience serving target groups of the IRIS program (adults with intellectual/physical disabilities or older adults), or equivalent combination of relevant education and experience. • Bachelor’s degree in a social work, psychology, human services, counseling, nursing, special education, or a closely related field (or four years of commensurate experience if no degree). • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements unless otherwise required by law. • Ability to develop positive and effective work relationships with coworkers, clients, participants, providers, regulatory agencies and vendors. • Ability to work independently with minimal supervision and demonstrate self-motivation. • Demonstrated knowledge of long-term care programs. • Familiarity with principles of self-determination. • Problem-solving and critical-thinking skills. • Excellent time-management and prioritization skills. • Ability to focus on multiple projects simultaneously and adapt to change. • Ability to develop and maintain professional relationships and work through challenging situations. • Comfortable working within a variety of settings with ability to adjust style as needed to work with diverse populations, various personalities, and personal situations. • Demonstrated knowledge of community resources. • Proactive and detail-oriented. • Excellent verbal and written communication skills. • Microsoft Office suite/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 Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Summary VP, Data & Analytics (Enterprise Insights & Business Intelligence) with enterprise-wide influence across MedEcon, Payment Integrity, Claims, Configuration, UM, Provider, and other core functions. Essential Job Duties Serve as the enterprise leader for Insights and Business Intelligence, partnering with executive and operational leaders across Molina to identify, prioritize, and deliver analytics initiatives that improve affordability, quality, provider performance, operational efficiency, and member outcomes. Act as a strategic advisor to business leaders, proactively uncovering opportunities where data, analytics, and AI can solve critical business challenges, accelerate decision-making, and enable measurable financial and operational impact. Build and execute a portfolio of high-value analytics and intelligence solutions, translating business priorities into scalable reporting, dashboards, predictive insights, and decision-support capabilities that drive enterprise results. Lead the adoption of AI-enabled analytics and intelligent automation, recommending and applying advanced AI, machine learning, and generative AI approaches where they can materially improve business outcomes, productivity, and competitive differentiation. Establish a culture of data-driven accountability, ensuring leaders have trusted, actionable, and timely insights while promoting consistent business definitions, governance, and measurement frameworks across the enterprise. Develop high-performing cross-functional teams and partnerships, aligning business, operational, technology, and analytics stakeholders to rapidly deliver insight-to-action solutions and realize sustained value from Molina's data and AI investments. Required Qualifications • At least 12 years of information technology (IT) applications/coding development experience in large organizations in the managed care industry, or equivalent combination of relevant education and experience. • At least 7 years of management/leadership experience. • Deep experience with Microsoft Azure cloud services (App Services, Functions, AKS, Azure SQL, Data Factory, Synapse, Azure DevOps, Azure AI). • Expert proficiency with Visual Studio and AI-assisted development using GitHub Copilot, Azure OpenAI, and generative AI technologies. • Experience setting enterprise quality assurance automation strategy and implementing testing frameworks at organizational scale. • Expert experience with low-code platforms (Pega, Salesforce, Sitecore) and enterprise architecture patterns. • Deep technical experience with IT enterprise infrastructure and Azure cloud architecture. • Specific domain expertise with government programs (Medicaid, Medicare, Marketplace). • Microsoft technologies, Mobility and Information Technology Infrastructure Library (ITIL) experience. • Experience working with Trizetto QNXT application and enterprise health care systems. • Deep understanding of IT concepts including test automation, software development lifecycle (SDLC), and IT general controls. • Hands-on experience with .NET framework and Azure serverless technologies. • Experience with global delivery models and working with third-party consultancies. • Fluent in modern DevOps frameworks based on Azure DevOps or Atlassian framework. • Forward Deployed Engineer leadership philosophy - proven track record building enterprise organizations focused on end-to-end business ownership. • Demonstrated executive presence and ability to build strategic relationships across C-suite and board levels. • Strong critical-thinking and problem-solving skills with focus on enterprise business transformation. • Health care payor industry experience, including deep Medicare/Medicaid operations and compliance knowledge. • Deep knowledge/experience with agile principles, CI/CD practices, DevOps culture, and Infrastructure as Code at scale. • Strong time-management and organizational skills with ability to lead enterprise strategic initiatives. • Ability to collaborate cross-functionally in a highly matrixed organization and influence at executive and board levels. • Excellent verbal and written communication skills with ability to present to executive and board audiences. • Experience with Microsoft Project/Jira, Microsoft O365 Cloud, Power BI, Azure DevOps, and applicable software programs proficiency. • Excellent verbal and written communication skills, and ability to present to executive audiences. Preferred Qualifications • Deep experience leading IT teams. • Azure certifications (Azure Solutions Architect Expert, Azure DevOps Engineer Expert). • Azure certifications (AZ-204, AZ-400). 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 Pay Range: $186,201.39 - $363,092.71 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Home Health Care, Hospice Care, Palliative Care, Long Term Care, Rehab No weekends, No afterhours support, No holidays Job Description Job Summary Are you seeking a unique nursing position that gives you a great work/life balance and lets you support people to live the lives that they choose? Then you’ll want to keep reading about this rewarding work opportunity! We are currently looking for a Registered Nurse licensed in Wisconsin to become our next IRIS Self-Directed Personal Care (SDPC) RN. This is a remote position, where you will partner with people in your community who are enrolled in the Wisconsin IRIS program – a Medicaid long-term care option for older adults and people with disabilities. People in the IRIS program who need personal care services have the choice to enroll in the IRIS Self-Directed Personal Care (IRIS SPDC) option. You can learn more about IRIS SDPC on the Wisconsin Department of Health Services website here , and learn about the IRIS program here . While this role is home-based, you will have regularly scheduled visits with people in their homes and communities. As an IRIS SDPC RN, you’ll provide oversight and guidance to the people enrolled in the IRIS SDPC option. You’ll also build relationships with the people you partner with and ensure that they’re getting the most out of the IRIS Self-Directed Personal Care option through assessment, oversight, training and education. IRIS SDPC RNs are responsible for administering the Wisconsin Personal Care Screening Tool; creating person-centered plans of care; providing personal care oversight to a group of people in IRIS, providing education and training for IRIS participants and care providers, and conducting the required documentation and follow-up. As an IRIS SDPC RN, you’ll play an important role in helping people of various backgrounds and abilities live their lives the way they choose. Knowledge/Skills/Abilities Provides personal care assessments and oversight to the My Cares Groups by administering the Wisconsin Personal Care Screening Tool and addendums as required Documents assessment as required by individual tool and Department of Health Services policies and by completing oversight visits and calls as required Oversees a My Cares Groups of participants, develops individual plans of care, ensures physician orders for care are obtained and reviews and revises plan of care as needed Submits for Prior Authorization for personal care services Complies with all Department of Health Services policies and SDPC Guidelines, procedures, and practices along with documentation and program regulations Provides personal care training to participants or care providers as requested and provides educational materials as needed Completes collateral contacts with IRIS Consultants and Long-Term Care Functional Screeners and physicians to ensure care needs are met Completes other duties as assigned Overtime work may be required May be required to drive 50% of the time during a given day of member home visits Exposure to members homes which may include navigating stairs, exposure to different environments, and pets Required Qualifications • At least 2 years nursing experience, and at least 1 year of experience serving the target groups of the IRIS program (adults with physical/intellectual disabilities or older adults), or equivalent combination of relevant education and experience. • Active and unrestricted Registered Nurse (RN) license in the state of Wisconsin. • Associate's degree in nursing. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements unless otherwise required by law. • Database operation/maintenance skills and data entry experience. • Teaching and mentoring skills. • Analytical and problem-solving skills. • Strong organizational and time-management skills, and ability to manage tasks independently. • Flexibility in the work environment, and willingness and ability to adapt to changing organizational needs. • Strong written and verbal communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Experience providing care through the Wisconsin Medical Assistance Personal Care program (MPAC). • Home care/home health experience. 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 Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long-term health care needs? Then TMG wants to hear from you! We’re currently looking for someone with a social services or human services background to join our team. This is a remote position, where you will partner with people in your community who are enrolled in the Wisconsin IRIS Program and the TMG IRIS Consultant Agency. While your office will be home-based, you will have regularly scheduled visits with IRIS participants in their home and community. As an IRIS Consultant (IC), you will build relationships with the people you partner with and help them navigate and get the most out of the Wisconsin IRIS program – a Medicaid long-term care option for older adults and people with disabilities. You can learn more about the IRIS program on the Wisconsin Department of Health Services website here . Together, you will identify the long-term care goals of the people enrolled in IRIS, and find creative ways to achieve those goals. ICs play an important role in helping people of various backgrounds and abilities live the lives that they choose. In fact, people constantly tell us how supportive our ICs are and what a positive impact our ICs have had on their lives! Successful candidates for this position will be compassionate, genuine, resourceful partners with an eye for high quality work, and who are excited to work side-by side with people enrolled in IRIS. As an IC, you will connect people to the resources available in their community. You will also help them develop customized IRIS plans for achieving their goals related to employment, housing, health, safety, community membership, transportation, and lasting relationships. While you will have a routine for the work that you do, no two days are alike! TMG wants to find the best possible candidates, so we created this Realistic Job Preview to provide you with an inside look at the position and our organization. Find out more about the IRIS Consultant position by clicking on the link and then reviewing the job posting below. TMG is committed to maintaining a diverse and inclusive workforce and prioritizes helping staff have a good work/life balance. Even though the position is remote, you’ll have lots of support from your TMG team and coworkers across the organization. If this sounds like the job for you, apply today! KNOWLEDGE/SKILLS/ABILITIES Required to meet in person with the IRIS participant a minimum of four times per year, with one required annual visit in the home of the participant. Because IRIS is a self-directed program, it is important for ICs to be available upon the request of the participant. Responsible for providing program orientation to new participants. During this time, participants will learn their rights and responsibilities as someone enrolled in the IRIS program, including verifying legal documents, completing employee paperwork and the responsible use of public dollars. Explore a broad view of the participant's life, including goals, important relationships, connections with the local community, interest in employment, awareness of the Self-Directed Personal Care option, and back-up support plans. Assist participants in identifying personal outcomes and ensure those outcomes are being met on an ongoing basis, all while staying within the participant's IRIS budget and within the requirements of the IRIS program determined by the Department of Health Services (DHS). Responsible for documenting all orientation and planning activities within the IRIS data system (WISITs) within 48 business hours of the visit with the participant. Research community resources and natural supports that will fit the individual outcomes for each participant and share that information with them as it becomes available. Responsible for documenting progress and changes as needed within the plan and the data system anytime a modification is requested by a participant. Budget Amendment or One-Time Expense paperwork may be required depending upon factors associated with the participant and their individual IRIS budget. Educate participants on how to read and interpret their monthly budget reports to ensure that participants operate within their budget. Being a liaison between the Fiscal Employer Agency and the IRIS Consultant Agency is also a large part of the position, which includes assisting participants with provider billing, seeking support brokers, tracking receipts, ensuring their workers are paid and mitigating areas of potential risk or conflicts of interest. Responsible to develop engaged and trusting relationships with participants and communicate program changes and compliance effectively. Responsible to maintain confidentiality and HIPPA compliance. Work collaboratively with other IRIS Consultant Agency staff in order to ensure a successful implementation of participants' plans. Attend in-person monthly team meetings with other ICs and their supervisor. In addition, weekly IC and IRIS Consultant Supervisor phone check-ins may occur, along with other duties as assigned. Required Qualifications • At least 2 years experience in health care, preferably in care coordination, and at least 1 year of experience serving target groups of the IRIS program (adults with intellectual/physical disabilities or older adults), or equivalent combination of relevant education and experience. • Bachelor’s degree in a social work, psychology, human services, counseling, nursing, special education, or a closely related field (or four years of commensurate experience if no degree). • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements unless otherwise required by law. • Ability to develop positive and effective work relationships with coworkers, clients, participants, providers, regulatory agencies and vendors. • Ability to work independently with minimal supervision and demonstrate self-motivation. • Demonstrated knowledge of long-term care programs. • Familiarity with principles of self-determination. • Problem-solving and critical-thinking skills. • Excellent time-management and prioritization skills. • Ability to focus on multiple projects simultaneously and adapt to change. • Ability to develop and maintain professional relationships and work through challenging situations. • Comfortable working within a variety of settings with ability to adjust style as needed to work with diverse populations, various personalities, and personal situations. • Demonstrated knowledge of community resources. • Proactive and detail-oriented. • Excellent verbal and written communication skills. • Microsoft Office suite/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 Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.