Molina Healthcare

Manage process improvement and organizational change projects within managed healthcare payer growth portfolio, including scheduling, costing, risk and issue management. | Bachelor's degree with project management coursework or 4-7 years experience; PMP or Six Sigma Green Belt preferred. | JOB DESCRIPTION Job Summary Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, planning and issue/risk management. KNOWLEDGE/SKILLS/ABILITIES * Deep understanding of effective project approach(es) for a variety of projects, including projects with a high degree of complexity spanning multiple areas. Able to organize complexity into successfully manageable work plans, estimate staffing requirements (e.g. resource skills & team assembly). * Expert knowledge of methods and techniques involved in project management initiatives. Able to develop detailed project plans, communication plans, schedules, role definition, risk management and assumptions. * Complete mastery of standard applications and project specific software. Able to learn new software with little to no instruction within a short timeframe and instruct others on its functionality. * Proactively assesses projects for potential problem areas. Investigates, develops, and evaluates solutions to a wide range of complex problems spanning across multiple projects. processes, procedures, and tools to increase efficiency. Projects may have broad cross functional impact and team organization. JOB QUALIFICATIONS Required Education Bachelor's degree and at least 1 PM course required. Required Experience 4-7 years of relevant work experience in business, engineering or a related field in lieu of degree acceptable. Preferred Education Additional formal training in PM preferred. Preferred License, Certification, Association PMP or Six Sigma Green Belt Certification desired.   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.

Implement health plan provider engagement strategies to improve quality and risk adjustment outcomes through data-driven coaching. | Requires 3+ years improving HEDIS quality scores and risk adjustment accuracy with data analysis proficiency. | JOB DESCRIPTION Job Summary Provides senior level support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes   Uses a consultative approach emphasizing physician engagement and behavior change through actionable data and analytics. Drives value-based care strategies through risk adjustment and quality improvement activities.  Ensures assigned Tier 1 & Tier 2 providers have engagement plans ensuring they meet annual quality and risk adjustment goals.  Drives coaching and collaboration with providers to improve performance through regular meetings and action plans.  Addresses practice environment challenges to achieve program goals and improve health outcomes.  Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for assigned providers - driving provider participation in Molina's risk adjustment and quality initiatives.    Essential Job Duties * Provides support for provider engagement activities including enhancing value-based strategies, and risk adjustment/quality improvement initiatives. * Ensures assigned Tier 1, Tier 2, and where applicable Tier 3, providers have a provider engagement plan to meet annual quality and risk adjustment performance goals.  * Drives provider partner coaching and collaboration to improve Medicaid, Medicare and Marketplace quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.  * Works with provider front-office staff to get the Molina members with the most open gaps on the schedule and seen by their assigned provider. Coordinates with Health Plan Community and Member Engagement resources to drive supporting effort on the member side. * Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.  * Drives provider participation in Molina risk adjustment and quality efforts (e.g. supplemental data, electronic medical record (EMR) connection, clinical profiles programs) and use of the Molina provider collaboration portal.  * Tracks all engagement and training activities using standard Molina provider engagement tools to measure effectiveness both within and across Molina health plans. * Serves as provider engagement subject matter expert; works collaboratively with health plan and shared service partners to ensure alignment to business goals.  * Collaborates with assigned health plan Provider Relations Network team member on operational, provider and member issues. * Accountable for use of standard Molina Provider Engagement reports and training materials.  * Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by health plan and corporate policies. * Communicates comfortably and effectively with internal and external stakeholders, including physician leaders, providers, practice managers, and medical assistants within assigned provider practices. * Provides training and support for new and existing practice transformation and provider engagement team members. * Maintains the highest level of compliance. * May require same day out-of-office travel up to 80% of the time, depending upon state/health plan requirements.   Required Qualifications * At least 3 years of experience improving population-level HEDIS quality scores and burden of illness documentation accuracy through provider engagement, or equivalent combination of relevant education and experience. * Experience with various managed health care provider compensation methodologies including but not limited to:  fee-for service (FFS), value-based care (VBC), and capitation. * Working knowledge of quality metrics and risk adjustment practices across all business lines. * Knowledge and understanding of HEDIS/NCQA and/or CMS STARs quality measures and risk adjustment practices across Medicaid, Medicare and Marketplace. * Proficiency with data analysis, manipulation, interpretation and reporting. * Critical-thinking, problem-solving and analytical skills. * Relationship building 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 foster and build relationships in a cross-functional highly matrixed organization to obtain buy-in and drive results * Effective verbal and written communication skills. * Microsoft Office suite (including Excel), Power BI, and other applicable software programs proficiency, and ability to learn new information systems and software programs. Preferred Qualifications *  Bachelor’s degree in Nursing, Health Administration or relevant discipline. * Solid understanding of health insurance, provider messaging/design and project management. * Strong experience using Microsoft products, including Excel (knowledge of pivot tables, VLOOKUP, etc.) and PowerPoint.     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

Serve as strategic liaison between business and IT to align technology with business needs and manage cross-functional projects. | Bachelor's degree and 6-8 years experience in Managed Care or IT system delivery, with preferred certifications. | JOB DESCRIPTION Job Summary Responsible for leveraging the technology for the benefit of the business. Interface and manage strategic relationships with business partners by representing & promoting IM capabilities. KNOWLEDGE/SKILLS/ABILITIES * Builds and maintains effective and trusting business relationships with both external and internal stakeholders such as health plan Senior Leadership/Senior Management and/or Corporate Executives, Molina Medical Solutions, other IT functions to understand their business needs, strategies, priorities and key issues. * Documents, manages and maintains state service level agreements for compliance deliverables for IT. * Builds, manages and maintains effective Business relationships with key stakeholders in business domain across various domain areas. * Works as a liaison between the business, Shared Services and IT to deliver key business initiatives, process improvements, manage service level agreements and business communications for their assigned line of business. * Provides knowledge of business processes, IT technologies and process to inform appropriate project triage.  Consults with the business (as well as collaboration with IT) on project scope, assumptions, development progress and estimation. * Manages/oversees cross-functional projects to completion for any non-PMO or Domain-led projects. * Utilizes standard communication protocols and forums to consistently provide updates and promotion of IT services/projects, which includes support and maintenance of marketing plan to promote within IT organization, IT wins/major projects and improves IT value perception both with IT employees and with our business community. * Translates business needs into IT work product and or project requests. Assimilates and documents business needs project requests and benefit value documentation including high level IT requirements, compliance implications and cost benefit analysis. * Provides technical and process knowledge within IT across silos and business partners to support consulting, problem resolution/facilitation and effective intake and solutioning. Coaches and brings resources to bear on project deliverables including BRD, RRD, PR, and CR. * Demonstrates Healthcare business process and/or functional knowledge. * Demonstrates use of effective communications and soft skills to build and maintain effective business relationships on behalf of IT.  * Ability to manage high volume of Demand Intake requests from various Business partners across mutiple domain areas * Ability to identify high level deliverables for cost estimations and timelines.  * Maintains management/technical skills that can be utilized in the field to solve complex problems. * Demonstrates use of tools, techniques and communications soft skills to build and maintain effective business relationships on behalf of IT.  JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent combination of education and experience Required Experience 6 - 8 years experience in Managed care, IT system delivery or related experience Preferred Qualifications * Graduate Degree or equivalent combination of education and experience * Six Sigma Black Belt, PMI - Project Management Professional, ITIL Certification * 7-9 years years experience in Managed care, IT system delivery or related experience     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.

Technical ownership of SASE platform and enterprise data protection to ensure secure access and compliance. | Bachelor's degree and 5-7 years experience with SASE and DLP tools in regulated environments. | JOB DESCRIPTION Role Summary This role provides dedicated engineering ownership for Molina’s Secure Access Service Edge (SASE) platform and enterprise data protection capabilities, with supporting responsibility for endpoint resilience technologies such as Dell Absolute. The position is responsible for the design, stability, and operational effectiveness of secure access and data protection services that are critical to workforce access, vendor connectivity, and regulatory compliance. Key Responsibilities * Serve as the primary technical owner for Molina’s SASE / Secure Access platforms. * Design, implement, and maintain secure access policies for workforce, third‑party, and application access. * Lead troubleshooting, root‑cause analysis, and remediation of SASE‑related production issues. * Manage vendor escalations, upgrades, and roadmap alignment. * Assist on supporting Microsoft Purview Data Loss Prevention (DLP), sensitivity labeling, and cloud data controls. * Provide engineering oversight for endpoint persistence and recovery technologies (e.g., Dell Absolute) to ensure devices remain recoverable and enforceable. * Develop standards, documentation, and runbooks; support audit and compliance activities. * Develop AI Automation    JOB QUALIFICATIONS Required Education * Bachelor's Degree. Required Experience * 5-7 years of experience in security engineering. * Strong experience with SASE / Secure Web Gateway technologies, preferably Zscaler. * Working knowledge of data protection / DLP, preferably Microsoft Purview. * Experience with endpoint persistence or recovery platforms such as Dell Absolute (or equivalent). * Experience working in a regulated enterprise environment. * Industry certifications preferred.   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.

Architect and implement scalable big data management solutions and lead a data team. | Bachelor's degree with 5-7 years in data management, expertise in Hadoop, Spark, and stream-processing preferred in healthcare/payment integrity. | Job Summary  Responsible for all the aspects of architecture, design and implementation of Data Management solution using Big Data platform on Cloudera or Hortonworks and other areas of enterprise application platforms.  Reporting and analytics are very important for this position.  Payment integrity is also important.  Please update your resume with any relevant previous experience.     Knowledge/Skills/Abilities  • Convert concepts to technical architecture, design and implementation  • Provide guidance on choosing ideal Architecture, Evaluating tools and Frameworks, define Standards & Best Practices for implementing scalable business solutions  • Implement Batch and Real-time data ingestion/extraction processes through ETL, Streaming, API, etc., between diverse source and target systems with structured and unstructured datasets  • Design and build data solutions with an emphasis on performance, scalability, and high-reliability  • Code, test, and document new or modified data systems to create robust and scalable applications for data analytics  • Build data model for analytics and application layers  • Contribute to leading and building a team of top-performing data technology professionals  • Help with project planning and scheduling  • Expert level experience on Hadoop cluster components and services (like HDFS, YARN, ZOOKEEPER, AMBARI/CLOUDERA MANAGER, SENTRY/RANGER, KERBEROS, etc.)  • Ability to participate and lead, in solving technical issues while engaged with infrastructure and vendor support teams.    Job Qualifications Required Education Bachelor's Degree Required Experience • 5-7 years of data management experience. • Experience in building stream-processing systems, using solutions such as Kafka, Storm or Spark-Streaming. • Proven experience on Big Data tools such as, Spark, Hive, Impala, Polybase, Phoenix, Presto, Kylin, etc. • Experience with integration of data from multiple data sources (using ETL tool such, Talend, etc.). • Experience building solutions with NoSQL databases, such as HBase, Memsql. • Strong experience on Database technologies, Data Warehouse, Data Validation & Certification, Data Quality, Metadata Management and Data Governance. • Experience with programming language such as, Java/Scala/Python, etc. • Experience implementing Web application and Web Services APIs (REST/SOAP). Preferred Education Master's Degree Preferred Experience • 7-10 years of data management experience. • Experience in the healthcare industry is preferred. • Reporting and analytics are very important for this position.  • Payment Integrity experience is very important for this opportunity.    • Experience in the healthcare industry is preferred 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.

Manage internal business projects and programs, oversee governance, direct schedules and budgets, and present updates to C-level executives. | Bachelor's degree with 7-9 years experience preferred, graduate degree and 10+ years preferred, CPHQ certification preferred for senior program management. | ***Remote and must live in Texas*** JOB DESCRIPTION Job Summary Responsible for the Management of internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion.  Plans and directs schedules as well as project budgets.  Monitors the project from inception through delivery.  May engage and oversee the work of external vendors.  Assigns, directs, and monitors system analysis and program staff. These positions’ primary focus is project/program management, rather than the application of expertise in a specialized functional field of knowledge although they may have technical team members. Senior Program Management professional. Responsible for overall governance across all operational and strategic portfolio of projects; strong management and leadership skills; should be well experienced and comfortable presenting to C level executives; ability to drive structure and organization; extensive working knowledge of portfolio and project management tools and methodologies; ability to quickly assimilate information and make informed decisions; logical, analytical thinker with great influencing, written and verbal communication abilities;  ability to handle multiple priorities and deal with ambiguity; provide oversight over the strategic and operational portfolios; manage strategic relationship with Corporate EPMO and IT. Manage the issue escalation/resolution process.   KNOWLEDGE/SKILLS/ABILITIES * Manages programs using staff and matrixed resources with oversight from AVP and VP as needed * Serves as industry Subject Matter Expert in the functional area and leads programs to meet critical needs * Escalates gaps and barriers in implementation and compliance to AVP, VP and senior management * Consultative role, develops business case methodologies for programs, develops and coordinates implementation of business strategy * Collaborates and facilitates activities with other units at corporate and Molina Plans.   JOB QUALIFICATIONS Required Education Bachelor's degree or equivalent combination of education and experience Required Experience 7-9 years Preferred Education Graduate Degree or equivalent combination of education and experience Preferred Experience 10+ years Preferred License, Certification, Association CPHQ   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.

Manage project lifecycles including scope, schedule, resources, quality, and costs while collaborating with stakeholders and overseeing teams. | 3-5 years experience with project management skills, preferably PMP or Six Sigma certified, and knowledge of Medicaid or pediatric experience preferred. | Job Description Job Summary Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs, and monitors system analysis and program staff. These positions' primary focus is project/program management, rather than the application of expertise in a specialized functional field of knowledge although they may have technical team members. The Project Manager plans and executes internal HCS projects involving department or cross-functional teams of subject matter experts, delivering projects from the design process to completion in collaboration with others. Manages projects providing ongoing communication of goals, evaluation, and support to ensure compliance with standardized protocols and processes. May engage and oversee the work of external vendors. Focuses on process improvement, organizational change management, program management, and other processes relative to the business. Serves as a subject matter expert and leads projects to meet critical needs. Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Collaborates with operational leaders within the business to provide recommendations for process improvement opportunities. Conducts quality audits to assess Molina HCS staff educational needs and service quality and implement quality initiatives as appropriate. Creates business requirement documents, test plans, requirements traceability matrix, user training materials, and other related documentation. Knowledge/Skills/Abilities • Manages all aspects of assigned projects throughout the project lifecycle including project scope, schedule, resources, quality, costs, and change. • Develops and maintains detailed project plan to include milestones, tasks, and target/actual dates of completion. • Revises project plans as appropriate to meet changing needs and requirements. • Prepares and submits project status reports to management. • Schedules and conducts project meetings to include logistics, agendas, and meeting minutes. Job Qualifications Required Education Associate degree or equivalent combination of education and experience Required Experience 3-5 years Preferred Education Bachelor's Degree or equivalent combination of education and experience Preferred Experience Pediatric experience preferred Knowledge of Florida Medicaid preferred Preferred License, Certification, Association PMP or Six Sigma Green Belt certification #PJCorp 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: $60,415 - $117,809 / ANNUAL • Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Lead internal business projects and cross-functional teams to deliver products from design to completion, managing submissions, budgets, and process improvements. | Bachelor's degree, 7-9 years experience, PMP certification required; graduate degree and additional certifications preferred. | JOB DESCRIPTION Job Summary Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs, and monitors system analysis and program staff. These positions' primary focus is project/program management, rather than the application of expertise in a specialized functional field of knowledge although they may have technical team members. KNOWLEDGE/SKILLS/ABILITIES * Leads CMS/HPMS submission activities and ongoing monitoring, including Health Service Delivery (HSD) tables and Exception Requests associated with Service Area Expansions (SAE) and triennial network adequacy reviews. * Coordinates with Product and Markets teams to ensure accurate and timely updates on expansion counties for Notices of Intent to Apply (NOIAs), Notices of Intent to Deny (NOIDs), and service area withdrawals. * Conducts regulatory documentation review within Inovarre and ensures alignment with CMS regulatory requirements, including updated network adequacy guidance, templates, and supporting documentation. * Manages people who lead teams in planning and executing business programs.  Assigns and monitors work of program management staff providing support and direction. * Serves as the subject matter expert to Program Managers and in functional areas; leads programs to meet critical needs. * Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.  * Works with operational leaders within the business to provide recommendations on opportunities for process improvements. * Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations. * Develops, defines, and executes plans, schedules, and deliverables.  Monitors programs from initiation through delivery. JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent combination of education and experience Required Experience 7-9 years Required License, Certification, Association PMP Certification (and/or comparable coursework) Preferred Education Graduate Degree or equivalent combination of education and experience Preferred Experience 10+ years Preferred License, Certification, Association Six Sigma Black Belt Certification, ITIL Certification desired   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.

Manage Medicare program governance, capability delivery, and stakeholder communication. | 4+ years program/project management with operational process improvement and managed care experience. | JOB DESCRIPTION Job Summary Provides support to Molina’s Medicare segment through program management, including governance frameworks, internal and partner capability delivery oversight, program controls, playbooks and best practices, as applicable. Serves as a key interface between the Medicare Data & Analytics Team and internal stakeholders and owns internal processes supporting request intake, disposition, and execution oversight. Job Duties * Supports operational coordination across the team by tracking deliverables, managing task prioritization (including backlog and defect tracking), and ensuring work items remain aligned to team priorities and timelines. * At the direction of Medicare program leadership, supports portfolio management and/or initiative-specific change and project management. * Coordinates recurring meetings to support governance framework, prioritization discussions, and decision-making processes. * Tracks performance metrics, monitors team productivity, and helps ensure value realization from deployed solutions through structured reporting and oversight. * Communicates delivery expectations, status updates, issues and risks to Medicare Leadership and key stakeholders. * Identifies opportunities/gaps, provides recommendations on program enhancements to respective leadership team, implements recommended processes and trains users on them. * Collaborates with key stakeholders to support dissemination and adoption of program and reporting standards, processes, guardrails, and single source systems of truth. * Routinely reviews program documentation and collateral to ensure current and accurate reflection of business needs.  * Responsible for ensuring all business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentation are up-to-date and centrally stored for access by all Team members. * Utilizes project and task management tools (JIRA preferred) to track deliverables, maintain backlog visibility, and support operational coordination.  * Partners with internal Functional Areas, Legal, Compliance, and Information Security to ensure governance standards are upheld. JOB QUALIFICATIONS REQUIRED QUALIFICATIONS: * At least 4 years of Program and/or Project management experience, or equivalent combination of relevant education and experience. * Operational Process Improvement experience. * Managed Care experience, preferably in a shared service, CoE or matrixed environment * Experience with Microsoft Project and Visio.  * Strong presentation and communication skills.  PREFERRED QUALIFICATIONS: * Experience with Medicare programs   #PJCorp #LI-AC1 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.

Manage Medicaid program operations including policy, budget, governance, and performance tracking. | Requires 4+ years program/project management with managed care experience and proficiency in MS Project and Visio. | JOB DESCRIPTION Job Summary Provides support to Molina functional areas through program management, including policy, workflow and process documentation, management of program controls, vendor practices, budgets, governance frameworks, playbooks and best practices, and champion networks, as applicable.    Job Duties * Responsible for ensuring well-documented policies, workflows, program controls, internal and third-party practices, playbooks and best practices for respective program.      * Manages program budget, as applicable, supporting project prioritization. * Collaborates with Legal, Compliance, and Information Security to ensure governance standards are upheld. * Tracks performance metrics and ensures value realization from deployed solutions.  * Coordinates recurring meetings to support governance framework and decision-making processes, as needed.  * At the direction of program (CoE, Shared Service or other functional area) leadership, supports portfolio management and/or initiative-specific change and project management. * Collaborates with key stakeholders to support dissemination and adoption of program guardrails, processes, best practices and other collateral. * Routinely reviews program collateral to ensure current and accurate reflection of business needs.  * Identifies opportunities/gaps and provides recommendations on program enhancements to respective leadership team.  * Responsible for creating business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations. * Generates and distributes standard reports on schedule.   JOB QUALIFICATIONS REQUIRED QUALIFICATIONS: * At least 4 years of Program and/or Project management experience, or equivalent combination of relevant education and experience. * Operational Process Improvement experience. * Managed Care experience, preferably in a shared service, CoE or matrixed environment. * Experience with Microsoft Project and Visio.  * Strong presentation and communication skills.   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.

Lead internal business projects and cross-functional teams managing budgets, schedules, and vendors. | Bachelor's degree, 7-9 years experience, PMP certification mandatory; graduate degree and Six Sigma Black Belt preferred. | JOB DESCRIPTION Job Summary Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs, and monitors system analysis and program staff. These positions' primary focus is project/program management, rather than the application of expertise in a specialized functional field of knowledge although they may have technical team members. KNOWLEDGE/SKILLS/ABILITIES * Manages people who lead teams in planning and executing business programs.  Assigns and monitors work of program management staff providing support and direction. * Serves as the subject matter expert to Program Managers and in functional areas; leads programs to meet critical needs. * Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.  * Works with operational leaders within the business to provide recommendations on opportunities for process improvements. * Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations. * Develops, defines, and executes plans, schedules, and deliverables.  Monitors programs from initiation through delivery. JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent combination of education and experience Required Experience 7-9 years Required License, Certification, Association PMP Certification (and/or comparable coursework) Preferred Education Graduate Degree or equivalent combination of education and experience Preferred Experience 10+ years Preferred License, Certification, Association Six Sigma Black Belt Certification, ITIL Certification desired   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.

Manage internal business projects and programs, oversee governance across portfolios, and coordinate with C-level executives and Corporate EPMO. | Bachelor's degree with 7-9 years experience preferred; graduate degree and 10+ years experience preferred; CPHQ certification preferred for senior management. | JOB DESCRIPTION Job Summary Responsible for the Management of internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion.  Plans and directs schedules as well as project budgets.  Monitors the project from inception through delivery.  May engage and oversee the work of external vendors.  Assigns, directs, and monitors system analysis and program staff. These positions’ primary focus is project/program management, rather than the application of expertise in a specialized functional field of knowledge although they may have technical team members. Senior Program Management professional. Responsible for overall governance across all operational and strategic portfolio of projects; strong management and leadership skills; should be well experienced and comfortable presenting to C level executives; ability to drive structure and organization; extensive working knowledge of portfolio and project management tools and methodologies; ability to quickly assimilate information and make informed decisions; logical, analytical thinker with great influencing, written and verbal communication abilities;  ability to handle multiple priorities and deal with ambiguity; provide oversight over the strategic and operational portfolios; manage strategic relationship with Corporate EPMO and IT. Manage the issue escalation/resolution process.   KNOWLEDGE/SKILLS/ABILITIES * Manages programs using staff and matrixed resources with oversight from AVP and VP as needed * Serves as industry Subject Matter Expert in the functional area and leads programs to meet critical needs * Escalates gaps and barriers in implementation and compliance to AVP, VP and senior management * Consultative role, develops business case methodologies for programs, develops and coordinates implementation of business strategy * Collaborates and facilitates activities with other units at corporate and Molina Plans.   JOB QUALIFICATIONS Required Education Bachelor's degree or equivalent combination of education and experience Required Experience 7-9 years Preferred Education Graduate Degree or equivalent combination of education and experience Preferred Experience 10+ years Preferred License, Certification, Association CPHQ   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.

Manage internal business projects and programs with cross-functional teams, overseeing schedules, budgets, and strategic portfolios. | 7-9 years experience, bachelor's degree, strong leadership and project management skills, ability to present to executives. | JOB DESCRIPTION Job Summary Responsible for the Management of internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs, and monitors system analysis and program staff. These positions’ primary focus is project/program management, rather than the application of expertise in a specialized functional field of knowledge although they may have technical team members. Senior Program Management professional. Responsible for overall governance across all operational and strategic portfolio of projects; strong management and leadership skills; should be well experienced and comfortable presenting to C level executives; ability to drive structure and organization; extensive working knowledge of portfolio and project management tools and methodologies; ability to quickly assimilate information and make informed decisions; logical, analytical thinker with great influencing, written and verbal communication abilities; ability to handle multiple priorities and deal with ambiguity; provide oversight over the strategic and operational portfolios; manage strategic relationship with Corporate EPMO and IT. Manage the issue escalation/resolution process. KNOWLEDGE/SKILLS/ABILITIES • Manages programs using staff and matrixed resources with oversight from AVP and VP as needed • Serves as industry Subject Matter Expert in the functional area and leads programs to meet critical needs • Escalates gaps and barriers in implementation and compliance to AVP, VP and senior management • Consultative role, develops business case methodologies for programs, develops and coordinates implementation of business strategy • Collaborates and facilitates activities with other units at corporate and Molina Plans. JOB QUALIFICATIONS Required Education Bachelor's degree or equivalent combination of education and experience Required Experience 7-9 years Preferred Education Graduate Degree or equivalent combination of education and experience Preferred Experience 10+ years Preferred License, Certification, Association CPHQ 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: $92,474 - $180,324 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Lead market finance strategy and performance, support rate negotiations, and collaborate across functions to improve financial and operational outcomes. | 12+ years finance experience including managed care, 7+ years leadership, healthcare analytics expertise, and strong communication and collaboration skills. | JOB DESCRIPTION Job Summary Provides executive level strategy and leadership for market finance activities - specifically provision of financial analysis to support business decisions including profitability initiatives for medical management metrics, member growth/retention ventures, targeted business extensions/expansions, rate advocacy efforts and other activities involving the finance function. Provides subject matter expertise and collaboration on enterprise projects and priorities including standardization of reporting, systems application, staffing models, and other enterprise workstreams. Market Location: Utah & Idaho Essential Job Duties • Supports executive strategy development, vision and direction for market finance activities. Demonstrates accountability for market finance performance and financial results, and keeps executive leadership apprised. • Coordinates efforts across market lines of businesses to ensure consistent processes for managing premium revenue including managed long-term services and supports (MLTSS) revenue management and appropriate risk adjustment. Reviews and analyzes premium rates within region for appropriateness. Develops analysis and arguments to support rate negotiations with states within designated market. • Collaborates with policy and planning and government contracts leadership to ensure a consistent message to policy makers on rate developments as applicable. Reviews and analyzes financial terms of provider agreements and rate developments to provide recommended changes. • Provides market support for provider report card/performance monitoring activities with regard to quality, pay for performance, clinical performance measurements, and quality improvement activities. • Develops and standardizes approach to manage medical expenses. Collaborates with medical affairs, operations and health care services leadership to improve medical management efficiency and identify/implement profit improvement initiatives across market. • Standardizes productivity measures for routine processing and administrative activities. Collaborates with senior leadership across all functions to establish standard metrics included in staffing models and identify opportunities for improvement. Reviews and analyzes regional administrative costs. • Monitors actual to budget/forecast performance. Identifies and implements appropriate responses to variances. • Works with shared services partners to support reporting, financial performance, common metrics and formatting and increase quality in all health care data analytical activities. Coordinates activities with enterprise to avoid duplication of work. • Represents finance by participating on committees and multidisciplinary teams as needed. • Standardizes encounters reconciliation activities across the market to ensure all encounters are successfully submitted and errors are resolved. Ensures the encounters process fully supports rate development, collection of case rate payments and maximizes risk scores while complying with state specific guidelines. • Provides financial and business leadership for designated market. Required Qualifications • At least 12 years of progressive finance experience, and/or analytical experience, and 5 years managed care/Medicaid experience, and 3 years programming, relational database and financial analysis experience, or equivalent combination of relevant education and experience. • At least 7 years management/leadership experience. • Bachelor’s degree in finance, accounting or related field. • Advanced training or experience in health care analytics. • Ability to build and maintain relationships, motivate and influence others. • Decision-making and problem-solving skills. • Ability to effectively collaborate with stakeholders across the organization and present at an executive level. • Strong critical-thinking and attention to detail. • Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. • Excellent verbal and written communication skills. • Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. • May be required to reside in specific market/health plan state. Preferred Qualifications • Certified Public Accountant (CPA). 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: $161,914.25 - $315,733 / ANNUAL • Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Lead analyst support for health plan payment integrity activities to improve financial performance and regulatory compliance. | Requires 4+ years business analyst experience in managed care, knowledge of Medicaid/Medicare programs, claims coding, and payment integrity. | JOB DESCRIPTION Job Summary Provides lead level analyst support for health plan payment integrity activities. Partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment integrity (PI) and provider claims accuracy. Makes recommendations that inform decisions which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of complex business challenges that impact cost-containment and regulatory compliance. Essential Job Duties • Business Leadership & Operational Ownership • Assists with and executes projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery, to improve encounter submissions, reduce general and administrative (G&A) expenses, and drive positive operational and financial outcomes for all payment integrity (PI) solutions. • Manages scorable action items (SAIs) related to pre-pay editing, post-pay audit, and overpayment recovery initiatives to ensure health plan SAI targets are met. • Leads efforts to improve claim payment accuracy and financial performance without needing extensive oversight. • Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies. • Serves as a thought partner to health plan leadership and provides well-reasoned recommendations that support short- and long-term business goals. • Partners with the network team to communicate recovery projects to ensure provider relations is informed and able to respond to provider inquiries. • Analyze data to identify and develop new recovery opportunities • Analyze data from Payment Integrity and Vendors against contracts, billing, and processing guidelines • Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies. • Conduct peer reviews of recovery concepts and offer recommendations for logical improvements; assist team members in their analysis of data sets and trends. • Responsible for documenting policies and procedures related to concept approvals • Conduct trainings and prepare training documentation for teams • Other duties as assigned Strategic Business Analysis • Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. • Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment integrity related recommendations and action plans. • Translates strategic needs into clear requirements, workflows, and solutions that drive measurable improvement. • Partners with finance and compliance to develop business cases and support reporting that ties operational outcomes to financial targets. • Applied Analytical Support • Uses data analysis tools/systems to support business analysis. • Validates findings and tests assumptions through data, and leads with contextual knowledge of claims processing, provider contracts, and operational realities. • Creates succinct summaries and visualizations that enable faster leadership decision-making. Required Qualifications • At least 4 years of business analyst experience in a managed care organization (MCO), and at least 2 years of experience in Medicaid and/or Medicare programs, or equivalent combination of relevant education and experience. • Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity. • Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules. • Strong data analysis/queries experience, and ability to analyze data to inform business decisions. • Strong business judgment, cross-functional coordination, and ownership of high-value deliverables. • Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment. • Strong written and verbal communication skills, including ability to synthesize complex information. • Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency. • Claims processing background • Experience with Medicare, Medicaid, and/or Marketplace lines of business. • Payment integrity (PI) programs Preferred Qualifications • Experience with Medicare, Medicaid, and/or Marketplace lines of business. • Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) certification. • Project management experience. • Familiarity with Medicaid-specific scorable action items (SAIs), operational cost-management efforts, payment integrity (PI) programs, and regulatory/compliance adherence. 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.

Extract and synthesize data to identify medical cost trends and financial risks, lead projects, develop financial models, and collaborate with teams to monitor medical interventions. | At least 3 years healthcare analytics or medical economics experience, bachelor's degree, proficiency in Excel, Power BI or Tableau, and understanding of managed care concepts. | JOB DESCRIPTION  Job Summary Provides support and ownership for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities and improve financial performance. Essential Job Duties • Extracts and compiles data and information from various systems to support executive decision-making. • Mines and manages information from large data sources. • Analyzes claims and other data sources to identify early signs of trends or other issues related to medical care costs. • Analyzes the financial performance, including cost, utilization and revenue of all Molina products - identifying favorable and unfavorable trends, developing recommendations to improve trends and communicating recommendations to leadership. • Draws actionable conclusions based on analyses performed, makes recommendations through use of health care analytics and predictive modeling, and communicates those conclusions effectively to audiences at various levels of the enterprise. • Performs pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives. • Collaborates with clinical, provider network and other teams to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions. • Collaborates with business owners to track key performance indicators of medical interventions. • Proactively identifies and investigates complex suspect areas regarding medical cost issues, initiates in-depth analysis of suspect/problem areas and suggests corrective action plans. • Designs and develops reports to monitor health plan performance and identify the root causes of medical cost trends - with root causes identified, drives innovation through creation of tools to monitor trend drivers and provides recommendations to senior leaders for affordability opportunities. • Leads projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports. • Serves as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes • Provides data driven analytics to finance, claims, medical management, network, and other departments to enable critical decision making. • Supports financial analysis projects related to medical cost reduction initiatives. • Supports medical management by assisting with return on investment (ROI) analyses for vendors to determine if financial and clinical performance is achieving desired results. • Keeps abreast of Medicaid and Medicare reforms and impact on the Molina business. • Supports scoreable action item (SAI) initiative tracking to performance. Required Qualifications • At least 3 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience. • Bachelor’s degree in statistics, mathematics, economics, computer science, health care management or related field. • Demonstrated understanding of Medicaid and Medicare programs or other health care plans. • Analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) • Proficiency with retrieving specified information from data sources. • Experience with building dashboards in Excel, Power BI, and/or Tableau and data management. • Knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) • Knowledge of health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). • Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.  • Understanding of value-based risk arrangements • Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. • Ability to mine and manage information from large data sources. • Demonstrated problem-solving skills. • Strong critical-thinking and attention to detail. • Ability to effectively collaborate with technical and non-technical stakeholders. • Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. • Effective verbal and written communication skills. • Proficient in Microsoft Office suite products, key skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.    Preferred Qualifications • Proficiency with Power BI and/or Tableau for building dashboards.   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

Lead and manage support center team to ensure excellent customer service and operational performance. | Requires 7+ years customer service/call center experience with 3-5 years management, strong customer service, and knowledge of insurance products. | JOB DESCRIPTION Job Summary Leads and manages team responsible for provision of support center customer service excellence to meet the needs of Molina members and providers. Ensures issues and needs are addressed fairly and effectively, and in alignment with Molina values. Demonstrates accountability for delivery of product and service information, identifies opportunities to improve the member and provider experience, and supports continuous quality improvement initiatives related to member/provider engagement and retention. Essential Job Duties • Provides leadership and oversight for the member and provider support center; ensures exemplary service is delivered according to Molina goals/objectives/policies/procedures and regulatory requirements, and demonstrates accountability for performance and financial outcomes. • Provides exemplary customer service to members, co-workers, vendors, providers, government agencies, business partners and the general public. • Assists representatives with questions and escalated calls; recognizes trends and patterns in call types and engages leadership with suggested solutions. • Identifies new opportunities for process development to improve support center operations and the member/provider experience. • Recommends and implements programs to support member and provider needs. • Develops and implements interventions to address deficiencies and negative trends. • Provides technical expertise and handles escalated calls. • Supports training needs of departmental employees. • Ensures compliance with state and regulatory requirements. • Collaborates with leadership and cross-functionally to coordinate problem-solving in an effective and timely manner. • Achieves individual performance goals as it relates to call center objectives. • Demonstrates personal responsibility and accountability by meeting attendance and schedule adherence expectations. • Sets a positive example for others and builds the Molina culture by modeling the Molina mission, vision and values in daily actions. • Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department-specific goals. • Models dynamic leadership for support center leaders and representatives; develops team to focus on delivering great health care/customer service to underserved populations. Required Qualifications • At least 7 years of customer service, call center and/or sales experience in a fast-paced/high-volume environment, including 5 years of call center experience, or equivalent combination of relevant education and experience. • At least 3-5 year of management/leadership experience. • Strong customer service skills. • Understanding of insurance products including Medicaid, Medicare and Marketplace/enrollment processes. • Organizational and time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. • Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA). • Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers. • Ability to work cross-functionally across a highly matrixed organization. • Strong verbal and written communication skills. • Microsoft Office suite and applicable software programs proficiency. Preferred Qualifications • Systems training/experience for the following : Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing, CVS Caremark, Availity. • Managed care/health care experience. • Broker/health insurance license. 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: $63,435 - $123,699 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Manage enrollment growth strategies and lead community engagement teams to achieve membership targets. | Requires 5-10 years in business development or healthcare-related activities with supervisory experience and knowledge of Medicaid managed care. | Molina Healthcare of Florida is hiring for a Manager of Growth & Community Engagement. This role will be traveling the state of Florida from 50 to 75%. Bilingual, Spanish speaking highly desired. Responsible for achieving established goals improving Molina’s enrollment growth objectives encompassing all lines of business. Works collaboratively with key departments across the enterprise to improve overall choice rates and assignment percentages. Knowledge/Skills/Abilities • Works closely with the AVP/Director to develop and execute the enrollment growth strategy for a specific area, while also being accountable to achieve assigned membership growth targets. • Accountable for achieving established goals with the primary responsibility for improving the plan's overall “choice” rate. In addition, works collaboratively with other key departments to increase Medicaid assignment percentages for Molina. • Responsible for day-to-day operations and management of team members, including hiring, training, developing, coaching and mentoring, etc. Creates and regularly reviews team performance metrics/scorecards to ensure team performance contributes to overall enrollment growth, while providing clear direction and intermittent steps to achieve success. • Contributes to the development, implementation, and evaluation of the enrollment growth plan for assigned territory; plans enrollment activities to promote membership growth. • Collaborates with other Lines of Business’ sales teams to identify growth opportunities focused on key providers and Community Based Organizations. • Leads team in the development of relationships with key providers, Community Based Organizations (CBOs), Faith Based Organizations (FBOs), School Based Organizations (SBOs) and Business Based Organizations (BBOs) and how to move them through the enrollment pipeline. • Directs the coordination, development and approval of State/Federal guidelines for all marketing and promotional materials for all product lines. • Demonstrates thorough understanding of Molina’s product lines, Medicaid, CHIP, Medicare SNP, Marketplace, MMP, etc. Job Qualifications REQUIRED EDUCATION: Bachelor’s Degree or equivalent experience. PREFERRED EDUCATION: Bachelor's Degree in Marketing or Healthcare Administration. Required Experience • 5-10 years’ experience in business development, community relations or health care related activities. • 3 years Managed-Care, Medicaid experience; knowledge of advertising requirements pertaining to the Medicaid and Medicare media campaigns. • Prior work experience in a supervisory capacity, demonstrating excellent organizational, prioritizing, and motivational skills. • Experience in negotiation, sales or marketing techniques. Preferred Experience • Previous healthcare enrollment, marketing and/or sales experience. • Fluency in a second language is highly desirable. • Prior demonstrated work experience in a managerial capacity. Required License, Certification, Association • Must have valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation. Preferred License, Certification, Association • Active Life & Health Insurance • Market Place Certified #PJHPO 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: $66,456 - $129,590 / ANNUAL • Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Interpret regulatory requirements and coordinate with stakeholders to support system solutions, monitor policy updates, and ensure alignment across health plans and corporate areas. | At least 2 years in managed care or health insurance, strong analytical and communication skills, proficiency in Microsoft Office, with SQL and medical coding certification preferred. | JOB DESCRIPTION Job Summary Responsible for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable.  JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan developed requirements. * Monitors sources to ensure all updates are aligned.  * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. * Conducts analysis to identify root cause and assist with problem management as it relates to state requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Provides support for requirement interpretation inconsistencies and complaints. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation is agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 2 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience.   * Policy/government legislative review knowledge. * Strong analytical and problem-solving skills. * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams. * Previous success in a dynamic and autonomous work environment. Preferred Qualifications * Basic SQL knowledge is preferred.  * Project implementation experience  * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA).  * Medical Coding certification.    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.

Lead and manage healthcare services programs focusing on project design, execution, compliance, and quality improvement to enhance member care. | At least 5 years healthcare experience with clinical licensure or certification, strong analytical and communication skills, leadership experience, and knowledge of Medicaid/Medicare populations. | Note: The job is a remote job and is open to candidates in USA. Molina Healthcare is a leading provider in healthcare services, and they are seeking a Program Manager for Clinical Systems. This role involves providing subject matter expertise and leadership in healthcare services, focusing on project design, execution, and compliance to enhance member care quality and cost-effectiveness. Responsibilities • Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion. • Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes. • May engage and oversee the work of external vendors. • Focuses on process improvement, organizational change management, program management and other processes relative to business needs. • Serves as a subject matter expert and leads healthcare services programs to meet critical needs. • Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. • Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate. • Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents. Skills • At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience. • Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. • Strong analytical and problem-solving skills. • Strong organizational and time-management skills. • Ability to work in a cross-functional, professional environment. • Experience working within applicable state, federal, and third-party regulations. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. • Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification. • Leadership experience. • Medicaid/Medicare population experience. • Six sigma certification • Experience with Agile Methodology • Experience with Epic Benefits • Molina Healthcare offers a competitive benefits and compensation package. Company Overview • Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals. It was founded in 1980, and is headquartered in Long Beach, California, USA, with a workforce of 10001+ employees. Its website is https://www.molinahealthcare.com. Company H1B Sponsorship • Molina Healthcare has a track record of offering H1B sponsorships, with 47 in 2025, 45 in 2024, 43 in 2023, 31 in 2022, 35 in 2021, 55 in 2020. Please note that this does not guarantee sponsorship for this specific role.