Molina Talent Acquisition

Manage internal business projects and programs, oversee schedules and budgets, and coordinate cross-functional teams from inception to delivery. | Bachelor's degree, 7-9 years of experience in program management, strong leadership skills, and familiarity with portfolio management tools and methodologies. | 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 involving cross-functional teams, overseeing schedules, budgets, and stakeholder communication. | Bachelor's degree, 7-9 years of experience, with preferred experience in managed care, Medicaid, Medicare, or healthcare program implementation. | 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 experience Managed Care industry experience - Medicaid, Medicare, Marketplace. Network Management and Public Policy New Program implementation experience (inpatient/outpatient) Behavioral Health - Configuration, PCM, Providers Billing Guides 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 project lifecycle from inception to delivery, and coordinate with cross-functional teams and external vendors. | Requires 7-9+ years of experience in program management, industry-specific knowledge in healthcare managed care, and leadership skills; your experience exceeds the seniority level and does not specify healthcare or managed care industry expertise. | 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 experience Managed Care industry experience - Medicaid, Medicare, Marketplace. Network Management and Public Policy New Program implementation experience (inpatient/outpatient) Behavioral Health - Configuration, PCM, Providers Billing Guides 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.

Leading enterprise-wide vendor management activities, developing strategies, overseeing vendor performance, and managing stakeholder relationships. | Extensive experience in healthcare, vendor management, data analytics, contract negotiation, and leadership. | JOB DESCRIPTION Job Summary Provides strategy and leadership to teams responsible for enterprise-wide vendor management activities - ensuring comprehensive operational efficiency, functional leadership engagement, sustainable governance of vendor relationships, and transparency and accountability in the delivery of services and products to Molina enterprise. Responsible for building and maintaining relationships with vendors, stakeholders, functional counterparts, and core operations leadership, and demonstrating a strong understanding of operations, stakeholder needs and satisfaction, financial budgets, and current and future program initiatives. Oversee vendor performance involving onshore and offshore resources and monitors regulatory compliance adherence (in conjunction with functional counterparts) and quality metrics. Accountable for offering innovative guidance and solutions to address emerging business concerns and respond to growth initiatives to appropriately scale vendor relationships to meet business demands, oversight of vendor performance against service level agreement (SLA) targets, compliance and performance metrics. Essential Job Duties • Supports strategy development, vision and direction for the vendor management function. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. • Collaborates with internal business partners to develop criteria and best practices for vendor selection. • Participates in the negotiation process of service level agreements (SLAs), ensures that contractual obligations are achieved, and initiates contract changes when required. • Provides assistance to procurement teams to optimize the cost-effectiveness of negotiations, and ensure compliance of negotiated agreements relating to regulatory requirements, services and products are met. • Demonstrates expertise in reviewing and communicating requirements for clarity, and ensuring minimization of change requests. • Leverages deep understanding of business requirements, deliverables, processes and technologies. • Manages all maintenance, enhancements or updates to processes, tools or vendor management relationships, including vendor tracking, analytics and vendor performance management. • Manages vendor contracts and oversees licensing and regulatory requirements. • Analyzes budget data and monitors return on investment (ROI) for vendor performance. • Serves as a liaison between stakeholders, vendors and internal leadership, and represents vendor performance through consistent and timely reporting and analytics of key performance indicators (KPIs) to senior leadership and key stakeholders throughout the business. • Manages vendor relationships as the key point of contact between specified vendors and the business. • Serves as a point of escalation for vendor issues and disputes; drives those issues to resolution. • Develops, implements and manages reporting of metrics and service level agreements (SLAs) that effectively measure team and vendor performance in line with the needs of the business. • Optimizes vendor relationships through contract management, financial and quantitative analyses and relationship management - effectively creating mutually beneficial opportunities. • Manages the collection, consolidation and communication of reporting and data on vendor contracts, performance, risk and relationships with key stakeholders and vendors. • Collaborates with vendors to ensure successful day-to-day operations and operational goals, and holds vendors accountable to commitments and deliverables. • Hires, trains, mentors, develops, and manages vendor management team, and demonstrates accountability for team performance. Required Qualifications • At least 10 years of experience in health care (payer experience), vendor management, data analytics, contract terms and conditions, procurement, project management, and/or account management, or equivalent combination of relevant education and experience. • At least 5 years management/leadership experience. • Ability to lead large cross-functional initiatives. • Ability to problem-solve and think critically to resolve business issues. • Strong data processing/analysis experience. • Strong time-management and organizational skills, and ability to manage multiple priorities. • Ability to collaborate cross-functionally across a highly matrixed organization. • Ability to develop and deliver executive presentations. • Strong project management experience. • Excellent interpersonal and verbal/written/presentation skills. • Microsoft Office suite proficiency (including Excel), and ability to learn/navigate new software programs. Preferred Qualifications • Experience in an operations capacity. • Complex contract negotiation 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

Manage program documentation, budgets, stakeholder engagement, and process improvements to enhance provider and member experiences. | Minimum 4 years of program/project management experience, operational process improvement skills, managed care experience preferred, proficiency with MS Project and Visio, strong communication skills. | JOB DESCRIPTION Job Summary The Program Manager for the Nevada Health Plan provides analytical insights to identify opportunities for improvement in provider and member experience. 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.

Manage initial credentialing, recredentialing, sanctions monitoring, and provider data updates to ensure compliance and meet production goals. | High school diploma or GED, experience in administrative or production roles with strong computer skills and communication abilities, preferably in healthcare. | JOB DESCRIPTION Job Summary Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information. Job Duties • Evaluates credentialing applications for accuracy and completeness based on differences in provider specialty and obtains required verifications as outlined in Molina policies/procedures and regulatory requirements, while meeting production goals. • Communicates with health care providers to clarify questions and request any missing information. • Updates credentialing software systems with required information. • Requests recredentialing applications from providers and conducts follow-up on application requests, following department guidelines and production goals. • Collaborates with internal and external contacts to ensure timely processing or termination of recredentialing applicants. • Completes data corrections in the credentialing database necessary for processing of recredentialing applications. • Reviews claims payment systems to determine provider status, as necessary. • Completes follow-up for provider files on ‘watch’ status, as necessary, following department guidelines and production goals. • Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions. • Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare. • Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found. JOB QUALIFICATIONS Required Education: High School Diploma or GED. Required Experience/Knowledge Skills & Abilities • Experience in a production or administrative role requiring self-direction and critical thinking. • Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems. • Experience with professional written and verbal communication. Preferred Experience: Experience in the health care industry 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

Design and implement data analysis processes and solutions to support business decisions, develop reports and dashboards, and collaborate across departments. | 1-3 years experience with data analysis, associate's degree or equivalent, preferred bachelor's degree, and knowledge of quality/Medicare Stars preferred. | Job Summary Designs and implements processes and solutions associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and unstructured data from multiple disparate sources. Identifies and interprets trends and patterns in datasets to locate influences and provides recommendations and strategic/tactical plans based on findings. Collaborates within Care Connections and across departments to define requirements and understand business problems. Uses advanced mathematical, statistical, querying, and reporting methods to develop solutions. Develops information tools, algorithms, dashboards, and queries to monitor and improve business performance. Creates specifications for reports and analysis based on business needs and required or available data elements and works with Clinical Informatics to design. Creates solutions from initial concept to fully tested production products and communicates results to a broad range of audiences. Effectively uses current and emerging technologies. KNOWLEDGE/SKILLS/ABILITIES • Extracts and compiles various sources of information and large data sets from various systems to identify and analyze data. • Sets up process for monitoring, tracking, and trending department data, including quality measures, effectiveness of communications, and process improvements. • Works with internal, external and enterprise stakeholders, as needed, to research, develop, and document new standard reports and/or processes. • Implements and uses the analytics software and systems to support department goals. JOB QUALIFICATIONS Required Education Associate's Degree or equivalent combination of education and experience Required Experience 1-3 years Preferred Education Bachelor's Degree or equivalent combination of education and experience Preferred Experience 3-5 year Quality and/or Medicare Stars knowledge highly 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.

The Senior Analyst guides the investment of network partners through contract valuation and analysis to ensure access to quality healthcare services. They perform research and financial modeling to deliver actionable insights and support pricing strategies that drive down total cost of care. | A Bachelor's Degree in a relevant field and 5+ years of analytics experience in financial analysis or healthcare pricing is required. Advanced proficiency in SQL and Excel, along with experience in healthcare economics, is preferred. | Job Description Job Summary Sr. Analyst, Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality care with improved outcomes through better coordination and preventive care and develop payment strategies that give incentives to providers and healthcare systems that deliver better health, more affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable financial and even clinical insights to focus high priorities and attack underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by leveraging value-based care models. Knowledge/Skills/Abilities Develop key strategic reports and analysis using SQL programming, SQL Server Analytic Services (SSAS), Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard. Generate hospital performance analytics tools on a quarterly basis; develop reports on a regular basis using SQL, Excel, and other reporting software. Research, develop, analyze and recommend cost savings opportunities in alignment to support enterprise strategies Track, monitor, and report cost savings initiatives (hospitals, physicians, ancillary) trend analyses, and its performance on a monthly basis. Conduct financial modeling and analysis (including trend analysis) by utilizing NetworX Modeler and ETL systems to support negotiating strategies, modeling current and future contract rate proposals. Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of reimbursement changes, educate/consult the health plans on the financial impact. Work independently to support and validate Provider Network contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting Ability to translate contract rates and terms to evaluate the financial impact to effectively negotiate new or amended contracts (e.g. coding and chargemaster impact analysis) Strong written and verbal communication skills required to present analytical results and findings to health plans' senior management team and key stakeholder meetings (PowerPoint) Coordinates and provides peer review of our quarterly national contract performance analysis by team members to ensure timely deliverables to stakeholders requiring decision support. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. Provides peer review of pricing configuration to ensure accuracy of financial modeling Provides peer review of team members' presentations for total cost of care and profit improvement initiatives Support process improvements for the team's methods of collecting and documenting report / programming requirements Serves as a key resource on the more complex pricing and analysis issues Reviews work performed by others and provides recommendations for improvement. Job Qualifications Required Education Bachelor's Degree in Business, Finance, Mathematics, Economics, Data Science or Actuarial Sciences or equivalent experience Required Experience 5+ years of analytics experience in financial analysis, healthcare pricing, network management, healthcare economics or related discipline. 5+ years increasingly complex database and data management responsibilities Advanced level proficiency in Microsoft Excel Intermediate to advanced level proficiency in SQL 5+ years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics Preferred Education Master's Degree Preferred Experience Preferred experience in healthcare medical economics and/or strong financial analytics background Proactively identify and investigate complex suspect areas regarding medical cost issues Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc. Experience with industry standard normalization/reimbursement methodologies (APR-DRG, MS-DRG, EAPG, APC) 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. #PJHPO

Oversee and implement Medicare Stars quality improvement initiatives, manage projects and budgets, lead teams, and measure outcomes to improve Star Ratings. | Bachelor's degree with 3-5 years Medicare Stars program/project management experience, knowledge of Star Ratings, operational process improvement, Medicare experience, and proficiency with Microsoft Project and Visio. | Job Description Job Summary Molina Medicare Stars Program Manager functions oversees, plans and implements new and existing health care quality improvement initiatives and education programs. Responsible for Medicare Stars projects and programs involving enterprise, department or cross-functional teams of subject matter experts, delivering impactful initiatives through the design process to completion and outcomes measurement. Monitors the programs and initiatives 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 for Stars Program and Quality Improvement activities. Job Duties • Collaborates with teams & health plans impacted by Medicare Quality Improvement programs involving enterprise, department or cross-functional teams of subject matter experts, delivering products through the design process to completion. • Supports Stars program execution and governance needs to communicate, measure outcomes and develop initiatives to improve Star Ratings • Plans and directs schedules Program initiatives, as well as project budgets. • Monitors the project from inception through delivery and outcomes measurement. • May engage and oversee the work of external vendors. • Focuses on process improvement, organizational change management, program management and other processes relative to the Medicare Stars Program • Leads and manages team in planning and executing Star Ratings strategies & programs. • Serves as the Medicare Stars subject matter expert in the functional area and leads programs to meet critical needs. • Communicates and collaborates with health plans to analyze and transform needs and goals into functional requirements. • Delivers the appropriate artifacts as needed. • Works with Enterprise and Health Plan l leaders within the business to provide recommendations on opportunities for process improvements. • Monitors and tracks key performance indicators, programs and initiatives to reflect the value and effectiveness of Stars and Quality improvement programs • Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations. • Generate and distribute standard reports on schedule Job Qualifications REQUIRED EDUCATION: Bachelor's Degree or equivalent combination of education and experience. REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: • 3-5 years of Medicare Stars Program and Project management experience. • Demonstrated knowledge of and experience with Star Ratings & Quality Improvement programs • Operational Process Improvement experience. • Medicare experience. • Experience with Microsoft Project and Visio. • Excellent presentation and communication skills. • Experience partnering with different levels of leadership across the organization. PREFERRED EDUCATION: Graduate Degree or equivalent combination of education and experience. PREFERRED EXPERIENCE: • 5-7 years of Medicare Stars Program and/or Project management experience. • Managed Care experience. • Experience working in a cross functional highly matrixed organization. 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.

Design and develop custom health plan reports, educate users on report usage, analyze data trends, and support risk and quality interventions for Medicaid, Marketplace, and Medicare plans. | 1-3 years experience in managed care data analysis, SQL and PowerBI proficiency, familiarity with HEDIS and risk data, and a bachelor's degree or equivalent. | JOB DESCRIPTION Job Summary The Analyst, Risk and Quality Reporting role supports Molina’s Risk and Quality Health Plan team. This position designs and develops custom health plan reports to support local interventions, provider outreach, and tracks outcomes of the initiatives. Educates users on how to use reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. Job Duties Work with assigned health plan to capture and document requirements, build custom health plan reports, and educate health plan users on how to use reports Build intervention strategy reporting for the Risk and Quality interventions and measure gap closure. Build ad hoc reports as requested to track HEDIS performance and supplemental data monitoring Development and QA of custom health plan reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP Develop custom health plan reports related to managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates Assists and collaborates with the national Risk and Quality department with testing of pre-production reporting for the assigned health plan Calculate and track gap closure and intervention outcome reporting for the assigned state Work in an agile business environment to derive meaningful information out of organizational data sets through data analysis and data profiling Analyze data sets and trends for anomalies, outliers, trend changes, and opportunities, using databricks SQL, PowerBi, excel, and techniques to determine significance and relevance Assist 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 JOB QUALIFICATIONS REQUIRED QUALIFICATIONS: Bachelor's Degree or equivalent combination of education and work experience 1-3 years of experience in working with data mapping, data profiling, scrapping, and cleaning of data. 1-3 years of experience in a Managed Care Organization executing similar techno functional role that involves writing SQL Queries, Functions, Procedures, and Data design 1-3 years of experience working with Microsoft T-SQL, Databricks SQL and PowerBI Familiarity with Microsoft Azure, AWS or Hadoop 1-3 years of experience in Analysis related to health care reporting 1-3 years of experience in working with data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics Familiarity with HEDIS and Risk data 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.

The Specialist implements clinical quality member intervention initiatives and monitors intervention activities to ensure compliance with program standards. They also evaluate project activities to identify opportunities for improvement and support high-quality clinical care through community relationships. | An associate's degree or equivalent experience is required, along with 1-3 years in healthcare and at least 1 year in health plan quality member interventions. Preferred qualifications include a bachelor's degree in a relevant field and certifications such as CPHQ or CHCA. | Job Description Job Summary The Specialist, Member & Community Interventions implements new and existing clinical quality member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid) Executes health plan’s member and community quality focused interventions and programs in accordance with prescribed program standards, conducts data collection, monitors intervention activity including key performance measurement activities, reports intervention outcomes, and supports continuous improvement of intervention processes and outcomes. Job Duties Implements evidence-based and data-informed key member intervention strategies, which may include initiating and managing member and/or community interventions (e.g., removing barriers to care) and other federal and state-required quality activities Monitors and ensures that key member intervention activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions Creates, manages, and/or compiles the required documentation to maintain critical program milestones, deadlines, and/or deliverables Participates in quality improvement activities, meetings, and discussions with and between other departments within the organization Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with community-based organizations Evaluates project/program activities and results to identify opportunities for improvement Surfaces to the Manager and Director any gaps in processes that may require remediation Demonstrates flexibility when it comes to changes and maintains a positive outlook Other tasks, duties, projects, and programs as assigned This position may require same-day out-of-office travel 0 - 80% of the time, depending upon location This position may require multiple days out-of-town overnight travel on occasion, depending upon location Job Qualifications REQUIRED QUALIFICATIONS: Associate’s degree or equivalent combination of education and work experience 1-3 years’ experience in healthcare with 1-year experience in health plan quality member interventions, managed care, or equivalent experience Demonstrated solid business writing experience Operational knowledge and experience with Excel and Visio (flow chart equivalent) Excellent problem-solving skills PREFERRED QUALIFICATIONS: Bachelor’s Degree in preferred field: Nursing, Social Work, Clinical Quality, Public Health, or Healthcare Administration 1 year of experience in Medicare and in Medicaid managed care Certified Professional in Health Quality (CPHQ) Nursing License (RN may be preferred for specific roles) Certified HEDIS Compliance Auditor (CHCA) 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

The Provider Engagement Specialist implements the provider engagement strategy to achieve quality and risk adjustment outcomes. This role involves coaching providers, addressing practice challenges, and tracking engagement activities to improve health outcomes. | Candidates must have an Associate's degree or equivalent experience, along with 1-3 years in healthcare, specifically in provider quality performance improvement. Strong communication and data analytic skills are essential, along with operational knowledge of relevant software. | JOB DESCRIPTION Job Summary The Provider Engagement Specialist, role implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the smaller, less advanced Tier 2 and Tier 3 providers have engagement plans to 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 the Provider Engagement team. Communicates effectively with healthcare professionals and maintains compliance with policies. Job Duties • Ensures assigned Tier 2 & Tier 3 providers have a Provider Engagement plan to meet annual quality & risk adjustment performance goals. • Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution. • 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, 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 a Provider Engagement subject matter expert; works collaboratively within the Health Plan and with shared service partners to ensure alignment to business goals. • Accountable for use of standard Molina Provider Engagement reports and training materials. • Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities. • Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies. • Communicates comfortably and effectively with Physician Leaders, Providers, Practice Managers, Medical Assistants within assigned provider practices. • Maintains the highest level of compliance. • This position may require same day out of office travel approximately 0 - 80% of the time, depending upon location. JOB QUALIFICATIONS REQUIRED QUALIFICATIONS: • Associate’s degree or equivalent combination of education and work experience. • 1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience. • Working knowledge of Quality metrics and risk adjustment practices across all business lines • Demonstrates data analytic skills • Operational knowledge and experience with PowerPoint, Excel, Visio • Effective communication skills • Strong leadership skills" 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.

The representative provides customer support and service to Molina members and providers, resolving issues and addressing needs effectively. They also document inquiries and engage with internal and external departments to enhance member and provider experiences. | Candidates must have a high school diploma or equivalent and 1-3 years of sales or customer service experience in a fast-paced environment. Preferred qualifications include an associate's degree and familiarity with various software systems. | JOB DESCRIPTION Start Date: 10/27/2025 Shift: 10:30am – 7:00pm CST Job Summary Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences. Job Duties • Provide service support to members and/or providers using one or more contact center communication channels and across multiple states and/or products. To include, but not limited to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business. • Conduct varies surveys related to health assessments and member/provider satisfaction. • Accurately document pertinent details related to Member or Provider inquiries. • Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed. • Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations. • Aptitude to listen attentively, capture relevant information, and identify Member or Provider’s inquiries and concerns. • Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives. • Able to proactively engage and collaborate with varies Internal/ External departments. • Personal responsibility and accountability by taking ownership of providing resolutions in real time or through timely follow up with the Member and/or Provider. • Supports provider needs for basic inquiries and assistance involving member eligibility and covered benefits, Provider Portal, and status of submitted claims. • Ability to effectively communicate in a professionally setting. Job Qualifications REQUIRED EDUCATION: HS Diploma or equivalent combination of education and experience REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: 1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment PREFERRED EDUCATION: Associate’s Degree or equivalent combination of education and experience PREFERRED EXPERIENCE: 1-3 years Preferred Systems Training: Microsoft Office Genesys Salesforce Pega QNXT CRM Verint Kronos Microsoft Teams Video Conferencing CVS Caremark Availity 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.

The Provider Contracts Manager is responsible for negotiating contracts with Complex providers to ensure high quality and cost-effective healthcare services. This role also involves maintaining provider relationships and ensuring compliance with regulatory standards. | Candidates should have a Bachelor's Degree in a healthcare-related field and 5-7 years of contract-related experience in the healthcare field. Experience in provider contract negotiations and familiarity with managed healthcare compensation methodologies is also required. | Job Description Job Summary Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Negotiates agreements with Complex providers who are strategic to the success of the Plan, including but not limited to, Hospitals, Independent Physician Association, and complex Behavioral Health arrangements. Job Duties This role negotiates contracts with the Complex Provider Community that result in high quality, cost effective and marketable providers. Contract/Re-contracting with large scale entities involving custom reimbursement. Executes standardized Alternative Payment Method contracts. Issue escalations, network adequacy, Joint Operating Committees, and delegation oversight. Tighter knit proximity ongoing after contract. • In conjunction with Director/Manager, Provider Contracts, negotiates Complex Provider contracts including but not limited to high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines. Emphasis on number or percentage of Membership in Value Based Relationship Contracts. • Develops and maintains provider contracts in contract management software. • Targets and recruits additional providers to reduce member access grievances. • Engages targeted contracted providers in renegotiation of rates and/or language. Assists with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region. • Advises Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts. • Maintains contractual relationships with significant/highly visible providers. • Evaluates provider network and implement strategic plans with the goal of meeting Molina’s network adequacy standards. • Assesses contract language for compliance with Corporate standards and regulatory requirements and review revised language with assigned MHI attorney. • Participates in fee schedule determinations including development of new reimbursement models. Seeks input on new reimbursement models from Corporate Network Management, legal and VP level engagement as required. • Educates internal customers on provider contracts. • Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers. • Participates with the management team and other committees addressing the strategic goals of the department and organization. • Participates in other contracting related special projects as directed. • Travels regularly throughout designated regions to meet targeted needs Job Qualifications REQUIRED EDUCATION: Bachelor’s Degree in a healthcare related field or an equivalent combination of education and experience. REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: • 5-7 years contract-related experience in the health care field including, but not limited to, provider’s office, managed care organization, or other health care environment. • 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, group and hospital contracting, etc. • Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: Value Based Payment, fee-for service, capitation and various forms of risk, ASO, etc. PREFERRED EDUCATION: Master's Degree in a related field or an equivalent combination of education and experience PREFERRED EXPERIENCE: 3+ years in Provider Network contracting 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.

The Senior Analyst performs research and analysis of complex healthcare claims, pharmacy, and lab data to evaluate network utilization and cost containment. They are responsible for generating reports, analyzing data trends, and making recommendations based on findings. | Candidates must have a Bachelor's Degree in Finance, Economics, or Computer Science, along with 5-7 years of experience in database management and healthcare analytics. Basic knowledge of SQL and experience in analyzing financial and utilization metrics in healthcare is required. | JOB DESCRIPTION Job Summary Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. KNOWLEDGE/SKILLS/ABILITIES Develop ad-hoc reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, and other analytic / programming tools as needed. Generate and distribute standard reports on schedule using SQL, Excel, and other reporting software. Create new databases and reporting tools for monitoring, tracking and trending based on project specifications. Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and rework. Responsible for timely completion of projects, including timeline development and maintenance; coordinates activities and data collection with requesting internal departments or external requestors. Identify and complete report enhancements/fixes; modify reports in response to approved change requests; retain old and new report design for audit trail purposes. Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors. Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures. Assist 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. Maintains SharePoint Sites as needed. JOB QUALIFICATIONS Required Education Bachelor's Degree in Finance, Economics, Computer Science Required Experience 5-7 years increasingly complex database and data management responsibilities 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare Basic knowledge of SQL Preferred Education Bachelor's Degree in Finance, Economics, Math, or Computer Science Preferred Experience Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators: Proactively identify and investigate complex suspect areas regarding medical cost issues Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc. Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions Healthcare Analyst I or Financial/Accounting Analyst I experience desired Multiple data systems and models BI tools 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.

The Senior Analyst, Medical Economics analyzes key business issues related to cost, utilization, and revenue for Molina Healthcare products. They design reports to monitor health plan performance and identify root causes of medical cost trends, providing recommendations for affordability opportunities. | Candidates must have a Bachelor's Degree in a related field and at least 5 years of experience in healthcare. Proficiency in data analysis tools and a strong understanding of Medicaid and Medicare programs are essential. | JOB DESCRIPTION Job Summary The Senior Analyst, Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Designs and develops reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives innovation by creating tools to monitor trend drivers and provide recommendations to senior leaders for affordability opportunities. Responsible for conducting complex analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities. Job Duties Extract and compile information from various systems to support executive decision-making Mine and manage information from large data sources. Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs. Work with clinical, provider network and other personnel to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions. Work with business owners to track key performance indicators of medical interventions Perform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action plan Draw actionable conclusions based on analyses performed, make recommendations through use of healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterprise Analyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making Support Financial Analysis projects related to medical cost reduction initiatives Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare Job Qualifications Required Education: Bachelor's Degree in Mathematics, Economics, Computer Science, Healthcare Management, or related field. Required Experience, Knowledge, Skills, and Abilities: 5+ years of related experience in healthcare Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans Analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.) Proficiency with Excel and SQL for retrieving specified information from data sources. Experience with building dashboards in Excel, Power BI, and/or Tableau and data management Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) Knowledge of healthcare 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 healthcare Ability to mine and manage information from large data sources. Preferred Qualifications: Proficiency with Power BI and/or Tableau for building dashboards Experience with Databricks and TOAD Data Point 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.

Responsible for reviewing and resolving member and provider complaints while ensuring compliance with Medicare and Medicaid standards. This role involves preparing documentation, researching issues, and communicating resolutions effectively. | A high school diploma or equivalent is required, along with at least one year of relevant experience in healthcare or customer service. Strong verbal and written communication skills are essential for this position. | JOB DESCRIPTION *** Candidates must be based in Florida. ****** Job Summary Responsible for reviewing and resolving member & provider complaints and communicating resolution to members (or authorized) representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid. KNOWLEDGE/SKILLS/ABILITIES Enters denials and requests for appeal into information system and prepares documentation for further review. Research issues utilizing systems and other available resources. Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. Determines appropriate language for letters and prepare responses to appeals and grievances. Elevates appropriate appeals to the Appeals Specialist. Generates and mails denial letters. Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner. Creates and/or maintains statistics and reporting. Works with provider & member services to resolve balance bill issues and other member/provider complaints. JOB QUALIFICATIONS REQUIRED EDUCATION: High School Diploma or equivalency REQUIRED EXPERIENCE: 1 year of Molina experience, health claims experience, OR one year of customer service/provider service experience in a managed care or healthcare environment. Strong verbal and written communication skills. 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.