POSITION SUMMARY Responsible for supporting service coordination activities and functions for the STAR & CHIP population in accordance with Molina policies, procedures, and processes. Interacts with Molina Nurses, Medical Director and providers to ensure the delivery of high quality, cost effective healthcare for Molina members.
POSITION TITLE: Community Outreach Coordinator-Pierce County POSITION SUMMARY: Serve as a vital link between Molina Healthcare and the community by creating brand awareness and opportunities for Molina through grass root and community-based efforts.
POSITION SUMMARY Responsible for coordination of daily UM functions in accordance with Molina Healthcare of WA policies and procedures. Coordinates decisions for all services requiring a medical necessity review including: inpatient and outpatient hospital services, diagnostic testing, equipment, home health care, and high cost injectable drugs.
POSITION SUMMARY Responsible for coordination of daily UM functions in accordance with Molina Healthcare of WA policies and procedures. Coordinates decisions for all services requiring a medical necessity review including: inpatient and outpatient hospital services, diagnostic testing, equipment, home health care, and high cost injectable drugs.
POSITION SUMMARY Provide medical oversight in appropriateness and medical necessity of healthcare services provided to Plan members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards.
JOB SUMMARY Responsible for safely and effectively transitioning Molina members from acute or inpatient care to lower levels of care and/or home in a cost efficient manner. Provides assessment, planning, implementation, coordination, monitoring, and evaluation of services for Molina members as they transition care and follows them for at least 30 days.
POSITION SUMMARY Resolves Provider Reconsideration Requests (PRR) from providers relating to claims payment and requests for claim adjustments. Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.
MOLINA HEALTHCARE - MANAGER POLICY (WASHINGTON, DC) POSITION SUMMARY The policy manager has responsibility to help identify key issues in current Molina Healthcare markets and draft MHI policy initiatives aimed at passing healthcare reforms that would ensure sustainable funding for government-sponsored programs, expansion of those programs, and private-sector participation in the programs.
POSITION SUMMARY Responsible for the assessment and review, coordination and distribution of review decisions for members identified with medical, surgical, and long-term care, needs including home and community-based waiver recipients. Interacts with Medical Directors, HCS department staff, various other Molina staff and providers and practitioners to ensure timely receipt of decisions in accordance with Molina policies, procedures and processes.
POSITION SUMMARY : Responsible for supporting service coordination activities and functions for the STAR & CHIP population in accordance with Molina policies, procedures, and processes. Interacts with Molina Nurses, Medical Director and providers to ensure the delivery of high quality, cost effective healthcare for Molina members.
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