Molina Talent Acquisition

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.

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 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 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.