Molina Healthcare is hiring a Pharmacy Customer Service Representative. This role is remote for those who live in Florida only.  Bilingual- Spanish speaking is needed.

Our agents assist with all Medicaid member Pharmacy-related calls. You will assist the members with obtaining their medications. This is a pharmacy call center environment focused on first call resolution and the member's experience. 
Pharmacy Reps will be taking calls for the state of FL. Must be bilingual, and live in the state of FL. 
Shift times will be Monday through Friday 8:00a - 4:30p or 10:30a-7:00p EST, all dependent on business needs.

Essential Job Duties

• Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.
• Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards.
• Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
• Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies.
• Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated.
• Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes.
• Assists members and providers with initiating verbal and written coverage determinations and appeals.
• Records calls accurately within the pharmacy call tracking system.
• Maintains established pharmacy call quality and quantity standards.
• Interacts with appropriate primary care providers to ensure member registry is current and accurate.
• Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation.
• Proactively identifies ways to improve pharmacy call center member relations.

Required Qualifications

• At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience.
• Excellent customer service skills.
• Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc.
• Ability to multi-task applications while speaking with members.
• Ability to multi-task applications while speaking with members.
• Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors.
• Ability to meet established deadlines.
• Ability to function independently and manage multiple projects.
• Excellent verbal and written communication skills, including excellent phone etiquette.
• Microsoft Office suite (including Excel), and applicable software program(s) proficiency.

Preferred Qualifications

• 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.
• Health care industry 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 competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Same Posting Description for Internal and External Candidates

Pay Range: $11.09 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides senior level support for Molina enterprise quality improvement abstraction activities.  Responsible for data collection and abstraction of medical records for Healthcare Effectiveness Data and Information Set (HEDIS) and HEDIS-like initiatives and compliance, and supplemental data collection activities.  Meets chart abstraction productivity standards and minimum over read standards.

Essential Job Duties

• Facilitates HEDIS medical record review, including ongoing review of records submitted by providers and the annual HEDIS medical record review process.
• Participates in meetings with the national overread team, national quality training team, the regional HEDIS team, vendors and HEDIS auditors for quality/HEDIS review activities to coordinate medical records and quality-related initiatives.
• Participates in meetings with vendors to enable the medical records collection process.
• As needed, may collect medical records and reports from provider offices, load data into the HEDIS application, and compare documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed.
• Assists with quality projects and process improvement initiatives.
• Provides mentorship and training to new and existing quality abstraction team members.
 

Required Qualifications

• At least 3 years of experience in a health care quality/HEDIS-specific setting, and experience with medical record review and abstraction, or equivalent combination of relevant education and experience.
• Intermediate knowledge and understanding of HEDIS and NCQA.
• Critical thinking, problem-solving, and analytical skills.
• Attention to detail and organizational skills, with a focus on accuracy and consistency.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.
 

Preferred Qualifications

• Managed care experience.
• Experience with HEDIS audits (including but not limited to chart collection, project management, etc.).
• Advanced knowledge related to HEDIS and National Committee for Quality Assurance (NCQA).
• Registered Nurse (RN).  If licensed, licensed must be active and unrestricted in state of practice.
 

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: $19.64 - $42.55 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

• Drives commitment, support, ownership, accountability and results for cyber response, incident response, and crisis management activities. 
• Assists with cyber response/incident management program and process documentation including policies, procedures, frameworks, templates, and creates instructions in support of the program and meeting regulatory requirements. 
• Assists with documenting the standard operating procedures (SOPs), incident response playbooks, escalation protocols, etc. to facilitate response capabilities.
• Validates, tests, and identifies gaps in response strategies and communicates results to leadership.
• Reviews and provides input on select enterprise response systems, tools, and services to ensure effective planning, testing and response capabilities including out of band options.
• Conducts research and analysis to support cyber/incident response programs and projects. 
• Develops and conducts employee incident response training to create awareness for areas of responsibility.
• Supports enterprise threat and cyber crisis response activities including incident notifications and situational updates, employee emergency notifications, threat monitoring and analysis, notification of threat to appropriate stakeholders, cyber incident response team meeting coordination and minutes, state-specific incident response leadership, and support for impacted business operations.
• Prepares comprehensive, timely, and detailed response after-action reports. 
• Analyzes trends across incidents and exercises to recommend improvements that may not be apparent from looking at each incident or exercise in isolation.
• Periodically tests and ensures readiness of continuity tools, including tools for out-of-band notification or incident communications.
• Establishes and maintains communication with enterprise crisis management, incident response team, and state-specific response team members.
• Coordinates with cyber response teams, the Chief Information Security Officer (CISO), legal, privacy, and the Protection Services Operations Center (PSOC) to respond to and support cyber crisis situations.
• Develops, enhances, and improves enterprise crisis management, cyber response while supporting incident plans and state-specific response plans; ensures annual plan compliance requirements are achieved. 
• Assists in development of metrics and measurements supporting response programs evolution, validation, and business awareness.
• Implements processes, procedures and systems that will help ensure that the company’s continuity capabilities remain in compliance with all laws, regulations, and best practices.
• Assists in the evaluation, design and deployment of integrated systems and technology that support response, intelligence, service delivery, and organizational strategy.
• Maintains roster of cyber crisis management and incident response team members.
  Conducts annual training of all crisis management and incident response plans as changes are made to each location team; prepares comprehensive, timely, and detailed test reports. 
• Maintains lessons learned and remediation tracker; ensures response items requiring remediation are resolved within a timely manner.
  
  
   

• At least 7 years of operational experience across multiple cybersecurity disciplines and crisis management, including at least 3 years of corporate business experience in cyber response, incident response, crisis management, and/or disaster recovery, or equivalent combination of relevant education and experience. 
• Experience conducting risk assessments, business processes, or control auditing.
• Strong documentation skills, including detailed tracking, executive briefing, and reporting skills.
• Practical understanding of technical/security concepts including network architecture design, logical access controls, vulnerability management, encryption, and cloud computing.
• Strong problem-solving and analytical abilities, including the ability to critically evaluate information gathered from multiple sources, reconcile conflicts, decompose high-level information into details, and apply sound business knowledge.
• Strong organizational skills, self-starter, and ability to multitask and manage multiple projects, and maintain attention to detail.
• Strong team player, and ability to build and maintain customer relationships and work collaboratively with team members - some of which may be geographically distributed.
• Demonstrated focus on process development and implementation that spans organizational boundaries.
• Data analysis experience, and ability to create value added metrics/reporting. 
• Strong grasp and hands-on experience in cyber incident response, disaster response, and crisis management.
• Strong understanding of cyber response and recovery stages, and the fundamentals of incident response planning, testing, and exercises.
• Situational awareness, and ability to respond to incidents that pose a threat to company, property, data, or people.
• Risk management and cyber response software/systems experience.
• Familiarity with cyber trends – ransomware, malware, phishing, insider threat, etc. 
• Familiarity using ChatGPT and CoPilot, and using AI for research.
• Familiarity with industry best practices and standards for cyber and crisis events.
• Strong project management experience/skills. 
• Strong verbal and written communication skills, and ability to present information to internal/external stakeholders.
• Microsoft Office suite and applicable software program(s) proficiency.
  
  
   

• Deep experience with cybersecurity/crisis management industry standard tools and concepts. 
• Business Continuity Institute (BCI) and/or Disaster Recovery Institute International (DRII) certification.
• Certified Information Systems Auditor (CISA) and/or Certified Information Systems Security Professional (CISSP).

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.

Provides subject matter expertise and leadership for Medicare Stars quality improvement (QI) programs and activities.  Provides subject matter expertise in planning and implementing QI initiatives and education programs to support improved Medicare Star ratings.  Responsible for leading and managing Medicare Star projects and programs involving enterprise, department, cross-functional and health plan teams of subject matter experts, delivering impactful quality improvement initiatives through design process to completion and outcomes measurement.

Essential Job Duties

• Collaborates with cross-functional corporate and health plan teams on the development and implementation of enterprise Medicare Stars quality improvement (QI) programs and initiatives across the enterprise. 
• Manages, plans and executes Medicare Star ratings programs.
• Supports Stars program execution and governance needs; communicates, measures outcomes and develops initiatives to improve Star ratings.  
• Serves as the Medicare Stars subject matter expert to corporate functional areas/health plans, and leads programs to meet critical needs.
• Communicates and collaborates with health plans and Stars measure owners to analyze and transform needs and goals into functional requirements to maximize improvement opportunities.
• Leads health plan leadership discussions to provide recommendations, performance results and opportunity assessments for Medicare Stars improvement.
• Collaborates with operational leaders within the business to provide recommendations on opportunities for
process improvements, organizational change management, program management and other processes related to Medicare Star ratings.
• Facilitates process improvement, organizational change management, program management and other processes relative to the Medicare Stars Program.
• Plans and directs schedules for program initiatives, as well as program budgets.
• Develops, defines, and executes plans, schedules, and deliverables; monitors programs from initiation
through delivery through outcomes measurement.
• Monitors and tracks key performance indicators (KPIs), programs and initiatives to reflect the value and effectiveness of Stars and QI programs.
• Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documents.
• Monitors projects from inception through delivery and outcomes measurement.
• May engage and oversee the work of external vendors.
• Generates and distributes quality improvement/Medicare Stars standard reports timely.
 

Required Qualifications

• At least 6 years of Medicare Stars program and project management experience, or equivalent combination of relevant education and experience.  
• Demonstrated knowledge of and experience with Medicare Star ratings and QI programs.
• Advanced knowledge of the quality discipline, including metrics and performance standards. 
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• Experience developing performance measures that support business objectives.
• Solid business writing experience.
• Strong strategic-thinking skills.
• Strong proficiency with data analysis, manipulation, interpretation, reporting and data-driven decision-making.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to implement process improvement initiatives and drive change. 
• Ability to work independently in a fast-paced, deadline-driven environment.
• Ability to work in a cross-functional highly matrixed organization.
• Strong project management experience.
• Excellent verbal, written, and presentation communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.
 

Preferred Qualifications

• Strong Medicare Stars/quality improvement (QI) program experience.
• Six Sigma Black Belt Certification.
• ITIL (Information Technology Infrastructure Library) certification.
• Experience in leading significant cross-functional work.
• Strong project management 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: $65,792 - $142,548.59 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION

Job Summary

Provides analyst support for Molina enterprise risk and quality reporting activities.  Designs and develops reporting solutions to support Healthcare Effectiveness Data and Information Set (HEDIS) auditing, rate tracking, identification of targeted interventions, and performance metric outcome tracking.  Collects, validates, analyzes, and organizes data into meaningful reports for operational/strategic analysis and decision-making.

Essential Job Duties
• Collaborates cross-functionally with internal departments across the enterprise to capture and document quality-related reporting requirements; builds reporting solutions, and educates users on how to use reports. 
• Assists quality data analytics leaders in predictive intervention strategic analytics, and corresponding tracking of progress and impact of interventions.
• Assists with retrospective HEDIS rate tracking and supplemental data impact reporting.
• Develops medical record review project reporting to track progress and team productivity reporting. 
• Develops quality assurance (QA) reporting and automated analytical reporting modules for the Medicaid, Marketplace and Medicare/Medicare-Medicaid Plan (MMP) lines of business.
• Analyzes and reports managed care data including claims, pharmacy, lab and HEDIS rates.
• Assists quality department with HEDIS measure deep dives to support HEDIS audit and revenue at risk reporting. 
• Calculates and tracks HEDIS rates for all intervention outcomes for all markets and lines of business. 
• Works in an agile business environment to derive meaningful information out of complex/large data sets through data analysis, data mining, verification, scrubbing, and root-cause analysis.
• Conducts root-cause analysis for business data issues.
• Analyzes data sets and trends for anomalies, outliers, trend changes and opportunities using statistical tools and techniques to determine significance and relevance; utilizes extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance. 
• Assists with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.

 

Required Qualifications

• At least 2 years of experience mapping, scrubbing, scrapping, and cleaning data, and analysis experience related to HEDIS and/or risk adjustment, including experience working with relational databases, Microsoft Transact-SQL (T-SQL), SQL Server Integration Services (SSIS), SQL Server Reporting Services (SSRS), and Power BI, and at least 1 year of experience in a managed care organization, in addition to predictive modeling experience in health care quality and HEDIS rate tracking, medical record review tracking, interventions tracking, and statistical analysis/HEDIS forecasting experience supporting quality, finance, and health plan functions, or equivalent combination of relevant education and experience.
• Analytical mindset, excellent attention to detail, and problem-solving skills.
• Experience in working with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics.
• Experience working with Microsoft T-SQL, Databricks SQL and Power BI.
• Experience writing complex SQL queries, functions, procedures and data design.
• Experience with Microsoft Azure, Amazon Web Services (AWS), or Hadoop.
• Ability to manage multiple priorities in a fast-paced, deadline-driven environment.
• Strong business acumen with the ability to connect data insights to strategic goals.
• Ability to communicate complex analytical results clearly to non-technical audiences.
• Self-starter with a continuous improvement mindset.
• Effective verbal and written communication skills.  
• Microsoft Office suite proficiency.

Preferred Qualifications

• Familiarity with data science techniques and languages like Python and R programming.
 

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 Summary

This position will offer remote work flexibility, but the candidate selected for this role must reside in Florida. 

Leads and manages multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other 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

• Responsible for leading and managing performance of one or more of the following activities: care review, care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition of care, health management, behavioral health, long-term services and supports (LTSS), and/or member assessment.
• Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model.
• Manages and evaluates team member performance, provides coaching, employee development and recognition, ensures ongoing appropriate staff training, and has responsibility for selection, orientation and mentoring of new staff.
• Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care.
• Oversees interdisciplinary care team (ICT) meetings.
• Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities.
• Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
• Collates 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.
• Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement.
• Local travel may be required (based upon state/contractual requirements).

 

Required Qualifications

•At least 7 years experience in health care, and at least 3 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 equivalent combination of relevant education and experience.

• At least 1 year of health care 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.

• Experience working within applicable state, federal, and third party regulations.

• Demonstrated knowledge of community resources.

• Proactive and detail-oriented.

• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.

• Ability to work independently, with minimal supervision and demonstrate self-motivation.

• Responsive in all forms of communication, and ability to remain calm in high-pressure situations.

• Ability to develop and maintain professional relationships.

• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.

• Excellent problem-solving and critical-thinking skills.

• Excellent verbal and written communication skills.

• Microsoft Office suite/applicable software program(s) proficiency.

 

Preferred Qualifications

• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
• Medicaid/Medicare population experience.
• Clinical 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: $73,102 - $142,549 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION 

Opportunity for a Texas licensed LVN to join Molina as a Field Care Manager to work with our Medicare members in the service delivery area in Core Southeast Houston, covering areas that includes Pasadena, Pearland, Manvel, Clear Lake Shores, the Bay Area, and League City. You will complete assessments needed for determining the types of services our members are eligible to receive. Preference will be given to those candidates with previous experience working with the Medicare population within a Managed Care Organization (MCO). Mileage is reimbursed as part of our benefits package, but we are only considering candidates who are within 30 – 45 minutes of the coverage area. Hours are Monday – Friday, 8 AM – 5 PM CST.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, One Note and Teams as well as being confident in toggling between different programs to complete the necessary forms and documentation. 

Job Summary

Provides support for care management/care coordination long-term services and supports (LTSS)-specific activities.  Collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential.   Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.

 

Essential Job Duties

• Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care.
• Assesses for medical necessity and authorizes all appropriate waiver services.
• Evaluates covered benefits and advises appropriately regarding funding sources.
• Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns.
• Identifies critical incidents and develops prevention plans to assure member health and welfare.
• Collaborates with licensed care managers/leadership as needed or required.
• 25-40% estimated local travel may be required (based upon state/contractual requirements).

 

Required Qualifications

• At least 2 years of health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.
• 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.
• In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Demonstrated knowledge of community resources.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to operate proactively and demonstrate detail-oriented work.
• Ability to work independently, with minimal supervision and self-motivation.
• Ability to demonstrate responsiveness in all forms of communication and remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Problem-solving skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
• In some states, must have at least one year of experience working directly with individuals with substance use disorders.


Preferred Qualifications

• Certified Case Manager (CCM), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice.
• Experience working with populations that receive waiver services.

 

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: $24 - $46.81 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job Summary

Provides support for medical records collection activities. Supports quality improvement activities through outreach to providers for collection of medical records for Healthcare Effectiveness Data and Information Set (HEDIS) specific data collection, projects and audit processes. Contributes to overarching strategy to provide quality and cost-effective member care. 

This position is responsible for supporting Medical Records Collection for Florida and South Carolina. The candidate will need to commute to the Doral, Florida office one to to two times per month. The candidate will also need to travel to doctor offices and hospitals in the tri county area as needed to retrieve records.

Essential Job Duties 

• Outreaches to providers via phone call, fax, mail, electronic medical record system retrieval and direct on-site pick up for collection of medical records. 
• Loads medical records and reports from provider offices into the Healthcare Effectiveness Data and Information Set (HEDIS) application. 
• Supports annual HEDIS audit and other like audits, and organizes provider outreach, pursuit, collection and upload of provider medical records into the internal database. 
• Provides project management support to leadership via coordination, identification, pursuit and collection of medical records and other required data with other HEDIS staff. 
• Participates in meetings with vendors related to the medical record collection process. 
• Some medical records collection related travel may be required. 

Required Qualifications

 • At least 1 year customer service experience, preferably in an administrative support capacity in a health care setting, or equivalent combination of relevant education and experience. 
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements. 
• Excellent customer service and active listening skills. 
• Proficiency with data analysis tools (e.g., Excel). 
• Ability to manage files, schedules and information efficiently. 
• Ability to effectively interface with staff, clinicians, and leadership. 
• Strong prioritization skills and detail orientation. 
• Strong verbal and written communication skills, including professional phone etiquette. 
• Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. 

Preferred Qualifications 

• Registered Health Information Technician (RHIT). 
• Medical records collection experience. 
• Managed care experience. 
• Basic knowledge of Healthcare Effectiveness Data Information Set (HEDIS) and National Committee for Quality Assurance (NCQA). 
• Project planning 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: $14 - $26.42 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Description

Job Summary

Supervises and mentors a team focused on primary, urgent, and preventative care services in various non-clinical community settings such as homes, nursing facilities, shelters, and pop-up clinics, in any environment where members feel most comfortable and are receptive to care that aligns with Molina Healthcare’s philosophy and mission. 

Provides direct medical care to all levels of patients and population groups, for example, adult, geriatric, pediatric and women’s health.

Responsible for the day to day supervision of practitioners in assigned region(s). Works with the clinical leadership team to ensure practitioners are providing high quality care to patients and access to care is available to all patients. Provides real time training and mentoring to practitioners by rounding regularly and directly engaging in patient care. Provides education on clinical guidelines, coding, quality measures, and documentation excellence. 
 

Job Duties

• Provides evidence-based, high-quality patient care via in-person and telehealth visits based on clinical and business need.
• Leads a team of regional employees to ensure patient-focused and culturally sensitive medical care is delivered to patients.
• Travels to location of team members and performs hands on training, coaching, and mentoring of team in order to optimize performance and reach department and clinical goals.
• Performs performance management including coaching, monthly 1:1s, and end of year evaluations.
• Leads in the orientation of new practitioners and mentors new employees with hands on training and support via ride along for member visits.
• Performs and coordinates alternating on-call coverage to triage any urgent lab results or clinical needs and develop appropriate plan of care.
• Participates in the implementation of new clinical projects and onboarding staff.
• Using evidence-based guidelines, properly diagnoses and creates patient-focused plan of care and treatment.
• Orders/performs pertinent diagnostic laboratory and radiology testing, prescribes medication and durable medical equipment, and places referrals as clinically appropriate.
• Documents thoroughly and accurately in electronic medical records with a focus on ensuring continuity of care while complying with Health Insurance Portability and Accountability Act (HIPAA).
• Collaborates with other teams and leads direct reports with the goal of clinical outcomes, clinical documentation excellence, and exceeding department goals. 
• Addresses chronic and acute primary care complaints, ascertains medical urgency, and takes appropriate action based on evidence-based guidelines. Seeks specialty consultation as needed.
• Carries up to 50 lbs. of equipment daily. Equipment can be transported using a backpack or a rolling bag, depending on preference.
• Participates in community-based initiatives geared towards building relationships with the community while addressing gaps in health care, such as pop-up clinics and shelters.
• Drives up to 120 miles a day on a regular basis to a wide variety of locations within the assigned region(s) with potential for additional mileage on extended mileage days or special project days.
• Actively participates in and leads regional meetings hosted by managers, peers, senior leadership team and other department leads including workshops, townhalls, huddles, new programs, new pilots, and initiatives.

Job Qualifications

REQUIRED QUALIFICATIONS:

• At least 3 years of experience as a nurse practitioner, or equivalent combination of relevant education and experience, including experience as a Nurse Practitioner with Molina.
• Active and unrestricted national certification from one of the following organizations: American Academy of Nurse Practitioners (AANP) or American Nurses Credentialing Center (ANCC).
• Current state-issued license to practice as a Family Nurse Practitioner (FNP).
• Current Basic Life Support (BLS) certification.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements.
• Advanced computer skills. Proficient with Word, Excel, and Electronic Medical Record. 
• Strong verbal and written communication skills. 
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships with individuals.
• Excellent time management and prioritization skills; ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem solving and critical thinking skills.

PREFERRED QUALIFICATIONS:

• Leadership experience.
• Home visit/Home health experience.
• Bilingual

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

Pay Range: $111,893 - $218,192 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Summary

Provides non-clinical administrative support to the care management function, and contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 

Essential Job Duties 

• Facilitates administrative support including case assignment, member screening and scheduling, correspondence processing, data entry and telephone and clerical support for team facilitating care management related services for members. 
• Facilitates initial review of assigned case levels and assists in case management assignment to care managers. 
• Reviews data to identify principle member needs and works under the direction of the care manager to implement care plan. 
• Schedules member visits with care managers as needed. 
• Screens members according to Molina policies and processes and assists care management staff during process of identifying appropriate member services. 
• Coordinates required member services in accordance with member benefit plan. 
• Promotes communication both internally and externally to enhance effectiveness of care management services. 
• Processes member and provider correspondence. 

Required Qualifications

• At least 1 year of experience in an administrative support role in health care, or equivalent combination of relevant education and experience. 
• Strong attention to detail. 
• Problem-solving skills. 
• Working knowledge of Microsoft Office (Outlook, Word, Excel) or other comparable software. • Excellent customer service skills. • Time-management and organizational skills. 
• Strong verbal and written communication skills. 
• Microsoft Office suite/applicable software program(s) proficiency. 

Preferred Qualifications 

• Certified Medical Assistant (CMA). 

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: $14.9 - $29.06 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.