Molina Healthcare Jobs

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

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Those able to work MST or PST hours, preferred Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. Supports effective implementation of performance improvement initiatives for capitated providers. Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Assists in the development and implementation of physician education with respect to clinical issues and policies. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. Develops alliances with the provider community through the development and implementation of the medical management programs. As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. Represents the business unit at appropriate state committees and other ad hoc committees. Education/Experience: Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred. License/Certifications: Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association's Department of Certifying Board Services. Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs. Pay Range: $231,900.00 - $440,500.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Key Responsibilities: Serves as the point of contact for customer queries and resolution. Provides customer services relating to sales, sales promotions, installations and communications. Ensures that good customer relations and seamless turnaround in problem resolution are maintained and customer claims, product orders and complaints are resolved fairly, effectively and in accordance with the consumer laws. May answer questions and provide prompt information related to potential concerns. Develops organization-wide initiatives to proactively inform and educate customers. ***Shift Details - 11:30pm - 8:00pm Minimum Requirements: High School Diploma or GED Required Skills: Ability to complete multiple activities while utilizing excellent customer service skills Demonstrate ability to communicate clearly in both written and oral communication Maintains all patient confidentiality Other duties and responsibilities as assigned by supervisor. Career Level - IC-Business Support - B1 Additional Information ALL ANSWERS MUST BE "YES" Do you have a High School Diploma or GED? Are you able/comfortable working from home?

**Introduction** Do you want to join an organization that invests in you as a Sr Claims Supervisor? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. This is a Work From Home opportunity. **Benefits** HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity and Consumer Discounts + Retirement readiness, rollover assistance services and preferred banking partnerships + Education assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) + Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits (********************************************************************** **_Note: Eligibility for benefits may vary by location._** You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated Sr Claims Supervisor like you to be a part of our team. **Job Summary and Qualifications** This position is one of the professional staff positions in the HCI Claims Department and in the larger Risk & Insurance Department reporting to a Director of Claims. As the Senior Claims Supervisor, you are responsible for directly managing a caseload of the Company's professional liability. This includes retaining and supervising external and internal claims investigators, defense counsel and regularly interacting with various facility representatives and leaders. Ideally, this individual has experience managing physician practice and hospital claims and litigation management, is familiar with physician practice and hospital operations (including medical staff issues), state malpractice laws, possesses strong negotiation skills and has demonstrated ability to independently problem solve and proactively manage and resolve claims. Job Responsibilities: **Quality** + Handle professional medical malpractice liability cases with a designated caseload. This includes strategic thinking towards resolution, as well as collaborating, directing and managing outside counsel and other vendors as appropriate. + Engage in the department and company strategy and philosophy of proactive, efficient and effective claims management. + Continuous and appropriate documentation within, and maintenance of, the electronic claims system for caseload, including reviewing daily diaries of files to track progress and items needed for updates. + Identify appropriate cases and prepare those for presentation to the AVP, VP and Claims Committee for settlement authority and to excess and reinsurers as needed. + Maintain performance against department established metrics. + Evaluate the efficiency of outside defense counsel based on audits and metrics provided by HCI and firms. **Service** + Manage a segment of the Company's liability claims to achieve fair, efficient, timely exposure assessment, strategy development and ultimate resolution of matters. + Attend mediations and trials as the Company representatives with authority to resolve the claim. + Maintain current licensure needed to perform duties as required in territory assigned. + Oversight and administration of special projects as assigned by the Claims Director, HCI President and VP of Claims. + Have strong experience in coverage evaluation process and coverage issues pertinent to medical professional liability claims. + Have a strong understanding of risk transfer strategies, to include additional insured standing, contractual indemnity and collateral sources. + Maintain current knowledge of relevant industry trends, changes in laws and rules affecting liability claims management decisions. **People** + Work collaboratively with entire HCI Claims team, as well as other HCI departments such as Finance, Business Intelligence and Insurance. + Assist in evaluation and management of outside defense counsel and claim investigators within established guidelines. + Develop and maintain effective, efficient and respectful working relationships with the organization's Risk Managers, Patient Safety Directors, C-suite colleagues and Division leaders. + Conduct division and facility reviews highlighting specific claims and trends in order to support collaboration and quality of care. + Build and maintain strategic alliances and collaborative partnerships with the HCI Risk Management team, HCA Legal Department, Clinical and Physician's Services Group and other corporate departments that will mutually benefit the Claims Department and the organization. + Lead and/or participate in committees or task forces, as assigned. **Finance** + Setting appropriate reserves at the opening of a file and continually maintaining that reserve insuring it is aligned with the exposure for the Company throughout the lifetime of the claim. + Adhere to meaningful metrics to measure individual performance of management of designated caseload. + Ongoing monitoring of expenses and litigation fees. + Reviewing and payment of law firm legal invoices through an electronic platform. + Responsible for efficient, effective and accurate loss adjustment expenses and indemnity payments. **Education & Experience** + Bachelor's degree required + 5+ years of experience in claims' management, preferably in healthcare and preferably in a multi-state environment; knowledge of hospital and healthcare operations required + JD preferred + Defense and trial experience preferred + Certification in risk management or insurance, i.e. CPHRM, ARM, CPCU, etc. preferred + Adjuster's license in states in which HCI operates, especially Florida preferred + Must be eligible to apply for and obtain adjuster's license(s) in assigned jurisdictions required + Proficient computer skills with word processing and database competency required + Possess critical thinking, analytical and problem skills required HCA Healthcare (Corporate), based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled resources and opportunities to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and career advancement opportunities, every person has a solid foundation for success. Nashville is also home to our Executive Development Program, where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Sr Claims Supervisor opening. Qualified candidates will be contacted for interviews. **Submit your resume today to join our community of caring!** We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

**Become a part of our caring community and help us put health first** The Stars Member Engagement team and Preventive Care Pod is seeking a passionate, strategic, and collaborative teammate to accelerate preventive care efforts for Medicare Advantage members. The Program Delivery Lead will improve Stars quality metrics and member health outcomes by strategically identifying, developing, and implementing programs that make it easier for members to complete preventive visits with their PCP as well as complete appropriate cancer screenings. This associate will work on problems of diverse scope and substantial complexity, use independent judgement on analysis of variable factors, and own their work and project milestones. Due to the cross-functional nature of the work, this individual will work closely with multiple internal and external business partners to help ensure that progress is being made toward goals. A broad range of skills including strategic thinking, data interpretation, and program management will be required. The Program Delivery Lead will: + Work closely with the Preventive Care cross-functional Pod and the Stars Member Engagement team, HEDIS Operations team, and other internal business partners to design and implement initiatives that support long-term strategy + Work with vendors on programs as needed; Monitors program operations and results + Reviews and communicates results of internal and external programs + Prioritize strategic focus areas and make recommendations for cross-functional work teams through data-driven decision making + Competent to work independently at the most advanced level across multiple areas + Effectively communicate strategy and influence partners to impact Stars through story telling + Oversee current day-to-day operational functions, while mapping futuristic needs and enhancements + Identify and communicate opportunities and risks to business partners and leadership to anticipate downstream impacts **Key Competencies:** + Operational strategy development, prioritization and execution + Influence and strategic decision making + Program management + Adaptability in fast moving/changing environment + Analytical thinking and data interpretation **Use your skills to make an impact** **Role Essentials** + 8+ years of strategy development and implementation + Proficiency in evaluating complex data, using that data to tell a story, and presenting it clearly + Ability to interpret and leverage data and analytics to improve strategy and make recommendations + Experience in strategy consulting, business strategy, clinical and/or operations areas + Strong presentation skills + Demonstrated ability to articulate ideas effectively in both written and oral forms + Effective facilitator and influencer **Role Desirables** + Master's Degree in Public Health, Business Administration or a related field + Knowledge and experience in health care environment/managed care and/or Medicare Stars + Agile or product management certification a plus + Strong analytics background **Additional Information** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $115,200 - $158,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 06-24-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. The Strategic Finance team is hiring a Director in either Irving TX, Alpharetta GA, Richmond VA, The Woodlands TX, or Columbus OH. The Director of M&A Finance will support the company's efforts to drive financial and strategic decisions at McKesson. This role will assist the team with the financial evaluation of McKesson's M&A and capital deployment process as well as being responsible for providing competitive analysis of the industry. DCF Modeling experience is a MUST HAVE. This is an individual contributor role Key Responsibilities * Review valuation analysis for capital deployment developed by the business and assist in the preparation of capital presentations for Senior Leadership and board. * Creator of driver based operating models. * Accountable to finance senior leaders for development of the valuation analysis for M&A opportunities using discounted cash flow model and other relevant valuation practices. * Prepares detailed capital pipeline and forecast reporting for Senior Leadership. * Identify and report key financial risks and opportunities related to investments. * Responsible for analyzing earnings calls, investor days and other publicly available information to understand the competitive landscape, with a focus on potential impacts to McKesson. * Perform other ad hoc analysis, as needed. * Develops relationships with relevant internal stakeholders across the enterprise, including business units, corporate development, and other corporate functions. Minimum Requirement Degree or equivalent and typically requires 10+ years of relevant experience. Less years required if has relevant Master's or Doctorate qualifications. Critical Skills * Capability to coordinate multiple projects simultaneously with minimal direction, interact with business units throughout the organization and present the results * Financial reporting knowledge including: income statement, balance sheet and cash flow statement, net working capital, and capital expenditures. * Ability to apply financial and strategic analysis to companies, primarily publicly-traded competitors and other companies of interest. * Exceptional communications skills (clear and concise communication to senior leadership). * Written communications skills and the ability to concisely summarize key trends and analyses to management and other key stakeholders * Excellent PC skills with a solid working knowledge of Excel, PowerPoint, and other department. * Preference in having experience using Capital IQ. Salary: 151,200.00 - 201,600.00 - 252,000.00 USD Annual with 25% MIP Starting Pay is between $170,000 to $180,000 based on skills and qualifications for this role in the Irving, Texas area P5 We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. Our Base Pay Range for this position $151,200 - $252,000 McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. This position will be supporting our Washington State Plan. We are seeking a Registered Nurse with previous knowledge of behavioral health services, substance abuse, physical health/disease management, and long-term care. The candidate should also have experience supporting social service needs, possess community resources, and health promotion experience. The Health Home Care Coordinator must be comfortable with outreach calling to educate and enroll new potential members. Bilingual candidates are encouraged to apply. Further details will be discussed during the interview process. Work schedule Monday- Friday 8:00 AM to 5:00 PM PST Remote position- 50% with field travel- 50% within Centralia and Chehalis- Lewis County Washington RN licensure required KNOWLEDGE/SKILLS/ABILITIES Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment. Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals. Conducts face-to-face or home visits as required. Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. Maintains ongoing member case load for regular outreach and management. Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for Molina members. Facilitates interdisciplinary care team meetings and informal ICT collaboration. Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. Assesses for barriers to care, provides care coordination and assistance to member to address concerns. 25- 40% local travel required. RNs provide consultation, recommendations and education as appropriate to non-RN case managers. RNs are assigned cases with members who have complex medical conditions and medication regimens RNs conduct medication reconciliation when needed. JOB QUALIFICATIONS Required Education Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred. Required Experience 1-3 years in case management, disease management, managed care or medical or behavioral health settings. Required License, Certification, Association Active, unrestricted State Registered Nursing (RN) license in good standing. Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation. Preferred Education Bachelor's Degree in Nursing Preferred Experience 3-5 years in case management, disease management, managed care or medical or behavioral health settings. Preferred License, Certification, Association Active, unrestricted Certified Case Manager (CCM) 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. #PJNurse

Manages a team of professional Configuration Analysts. Responsible for operational activities for the assigned team, including accurate and timely implementation and maintenance of critical information on claims databases. Validate data to be housed on databases and ensure adherence to business and system requirements of Health Plans as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. **KNOWLEDGE/SKILLS/ABILITIES** + Meet and exceed all performance metrics and department goals. + Understand conflicts with teams and provide solutions. + Ensure all team members comply with company and legal requirements. + Ensure tasks are completed with accuracy and efficiency. Sets the right priorities and systematically identifies the root cause of challenges. + Works with the business and project development teams to assess and recommend the appropriate configuration design, solutions, and methodology for new and existing business. + Develops standard operating procedures and guidelines for the Configuration team. + Provides status reports and project updates to management and stakeholders. + Ensure staff have all the resources they need to perform at a high level. + Conduct performance reviews, training, and corrective action as appropriate. + Understanding of complex payment methodologies + Understanding of complex configuration solutions + Advanced knowledge of health care benefits. + Advanced knowledge of healthcare claims and claim processing from receipt through encounter submission. + Ability to adopt and utilize work tracking software + Strong business writing skills; proficient user of Microsoft Products including Word, Excel, Outlooks, Teams, SharePoint, PowerPoint, and Visio + Advanced knowledge of Excel preferred + SQL knowledge preferred + Coding certification preferred + Knowledge of configuration in QNXT strongly preferred **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree or equivalent combination of education and experience **Required Experience** 5-7 years **Preferred Education** Graduate Degree or equivalent combination of education and experience **Preferred Experience** 7-9 years To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $80,412 - $188,164 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. We are searching for a VP, Business Development Executive to join our Health System Sales Team and drive growth by closing deals with new IDNs and Health Systems across the Northeast region. This is a remote position where the ideal candidate will live in the territory. As the VP, Business Development Executive, you will drive revenue growth by prospecting, developing relationships, assembling and pitching solutions, and negotiating contracts to close with new and existing customers. In this highly visible role, you will make a direct impact improving the provider and patient experience and serve as the catalyst that grows our business to new heights. This role is compensated through a mix of base salary and an uncapped sales incentive plan that significantly rewards closing new business. Key Responsibilities * Build and manage a pipeline of prospective customers to achieve quota * Establish long-term customer relationships with C-Suite, Procurement, Financial and Clinical Executives to position McKesson as a trusted supply chain partner * Prompt and lead RFP response processes for new customer opportunities, including identifying contract cycles, inserting McKesson for consideration, and leading a cross-functional team through to submission * Uncover and understand prospective customers' business goals, objectives and challenges * Develop strong internal relationships to shape solutions that both meet customer needs and can be delivered upon by internal teams * Craft compelling written and verbal pitches that convey our value proposition and address customers' unique supply chain and healthcare delivery pain points * Negotiate contract terms and navigate internally across functions to close deals on terms that can be delivered upon * Develop solid understanding of market trends, customer needs, and competitive landscape to identify opportunities and make informed business decisions * Travel to industry events, tradeshows and headquarters customers * Report out on pipeline and progress to executive leadership Minimum Qualifications: * Degree or equivalent and typically requires 10+ years of relevant experience. Less years required if candidate has relevant Masters or Doctorate qualifications. Requirements: * 10+ years of executive-facing or enterprise sales / business development experience * 15+ years of professional experience * 5+ years of industry experience in medical distribution, IDNs, Health Systems or GPOs Critical Skills: * Proven track record of meeting or exceeding sales goals through new customer acquisition (i.e. "hunting") * Established commercial relationships with IDNs and Health Systems is highly preferred * Previous sales experience in medical distribution, IDNs, Health Systems or GPOs * Outstanding listening and negotiation skills * Ability to credibly overcome objections and navigate roadblocks to get deals signed * Outstanding written and verbal communication skills * Willing to partner collaboratively and respectfully with internal support teams * Able to bring in subject matter experts to move deals forward and do so seamlessly from the customers' perspective * Proficiency and willingness to use Salesforce * Ability and willingness to lead and influence cross-functional teams without authority * Strong business and financial acumen * Strong work ethic, self-discipline and a burning desire to win Additional Skills: * Able to prepare and deliver slides using PowerPoint * Able to review, navigate and absorb large Excel files * Proficient in Microsoft Office (Outlook, Excel, Word, PowerPoint) and using shared drives Travel: 25% - 50% travel with overnight travel may be required Education 4-year degree in business or related field or equivalent experience Physical Requirements * Significant amount of time performing computer and phone-based work is required Must be authorized to work in the US. Sponsorship is not available for this position We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. Our Total Target Cash (TTC) Pay Range for this position: $186,800 - $311,400 Total Target Cash (TTC) is defined as base pay plus target incentive. McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

Coordinates and supports the billing functions for assigned clinicians, across multiple practices and specialties. Works with the RCM vendor partner on daily revenue specific job functions, budget targets and all other responsibilities as assigned job functions/responsibilities; and reporting compliance issues/concerns in a timely and appropriate manner. **********

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers. Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements. Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure. Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters). Identifies specific practice needs where Centene can provide support. Develops, enhances and maintains provider clinical relationship across product lines. Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards. Ability to travel up to 75% of time to provider offices. Performs other duties as assigned Complies with all policies and standards This is HYBRID, provider facing position. Candidates must reside in Madison, Sangamon, St. Clair, Macoupin, or Jersey counties. Education/Experience: Bachelor's Degree or equivalent required 3+ years in HEDIS record collection and risk adjustment (coding) required One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CBCS required For IL Health Plan only: Must reside in IL or within a reasonable driving distance to assigned providers. Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

The Business Analytics Advisor role will be a member of the Express Scripts pharmacy pricing organization's dedicated Engine Redesign team. This team is responsible for developing and executing on a successful solution for revolutionizing the Cigna Group's pharmacy underwriting engines. This role will initially be focused on the redesign project (i.e. Project Apollo), transitioning to maintenance and support at the conclusion of the project in 2026. ESSENTIAL FUNCTIONS Develop and maintain core functionality within the Apollo Claims Engine (ACE) which is a Pharmacy Claims projection tool written using OCL code and eventually Python.. Develop to be a trusted advisor who can assist with designing & developing the methodology used in the Apollo Claims Engine. Engage with matrix partners to determine the level of complexity that we wish to add to the engine. Decisions on whether to add complexity should be informed by financial impact assessments. Work cross-functionally with the Cigna Pricing & Underwriting teams to ensure that ACE meets their needs. Help design the tools & processes used to set assumptions, as well as the tools used to testing updates to the ACE code. COMPETENCIES & SKILLS Experience using Python and/or OCL Strategic thinking Ability to solution complex problems Focus on process efficiency Collaborative Communicate effectively QUALIFICATIONS Bachelor's degree in Actuarial, Economics, Statistics, Mathematics, Finance. Experience with Python/OCL and advanced Excel. 4+ years relevant work experience in financial and business analysis. Ability to execute through ambiguity. Exceptional communication, analytical, and leadership skills. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. McKesson Pharmacy Systems (MPS) is seeking a high-performing Senior Software Engineer to join our growing Clinical Program Solution (CPS) Software Development team. MPS provides a suite of integrated pharmacy software solutions that support thousands of pharmacies across independent, chain, and hospital market segments nationwide. This position is remote and is part of McKesson Corporation (NYSE: MCK), headquartered in Irving, Texas. Position Overview: We are seeking a passionate and experienced Senior Software Engineer to join the Clinical Program Solution (CPS) Research & Development (R&D) team. If you have a strong background in software engineering and a proven ability to lead high-performing technical teams, we want to hear from you! In this role, you will: Empower development teams to excel and deliver high-impact results. Collaborate in an Agile environment alongside skilled engineers. Drive the design, development, and delivery of high-quality software solutions. Promote technical excellence, innovation, and best practices. Make a significant impact on the future of pharmacy technology while advancing your leadership and technical expertise. Key Responsibilities: Collaborate with and drive a diverse technical team to develop and deliver high-quality software. Design, develop, and maintain software applications with a focus on best practices. Actively participate in the creation and review of User Stories and technical specifications. Write clean, efficient code, including unit/integration tests, and perform code/design reviews. Identify, articulate, and resolve technical challenges while continuously improving code quality. Serve as a technical expert across multiple areas or complex features of the application. Lead design discussions and serve as a development lead for one or more applications or functional areas. Remediate defects by identifying root causes, implementing fixes, and ensuring high-quality testing. Develop a deep understanding of the retail pharmacy and clinical services domain, focusing on how customers use McKesson products. Minimum Requirements: Bachelor's degree in Computer Science, Software Engineering, or a related field, or equivalent experience. Typically requires 7+ years of relevant experience in software development. Critical Skills: Strong expertise in Object-Oriented Development (Java preferred). Extensive experience with relational databases (Oracle, SQL Server) and SQL. Experience with document-based databases (e.g., CosmosDB). Proficiency with Cloud Platform-as-a-Service (PaaS) solutions (Microsoft Azure preferred). Knowledge of web front-end frameworks (Angular preferred). Strong understanding of RESTful API architecture and development. Experience working in Agile development environments (Scrum, Kanban, SAFe). Additional Skills & Attributes: Passionate and creative technical developer who values people, relationships, and performance. A strong contributor to a positive, high-performance culture. A continuous learner with a drive for personal and professional growth. Demonstrated ability to drive initiatives to completion with a commitment to excellence. Critical thinker who respects the status quo but is not afraid to challenge it for continuous improvement. Innovative mindset with a passion for exceeding expectations. Excellent written and verbal communication skills, capable of conveying complex ideas to technical and non-technical audiences. Ability to mentor and support less experienced team members. Collaborate with Customer Operations to assist customers with software-related issues. Advocate for continuous improvement and best practices in software development. Opportunity to interact with customers, management, and coordinate across multiple projects and teams Occasional travel (0-15%) Candidates must be authorized to work in USA. Sponsorship is not available for this role. We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. Our Base Pay Range for this position $113,200 - $188,600 McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

Become a part of our caring community and help us put health first The Senior Cloud Solutions Engineer Supports development and execution of cloud implementation strategy within organization's existing IT infrastructure. The Senior Cloud Solutions Engineer work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Seeking a dynamic and well-seasoned Senior Telecom Engineer to join our innovative team specializing in Genesys Cloud CX and Workforce Management. In this role, you will be pivotal in deploying, optimizing, and maintaining our contact center solutions to enhance customer and employee engagement and improve operational efficiency. This position requires a strong understanding of telecommunications, Genesys Cloud CX and WFM solutions. The Senior Cloud Solutions Engineer Implements organization's cloud strategy from a technical perspective, including design, planning, integration, maintenance and support of cloud architecture. May work with stakeholders across organization to evaluate cloud systems and identify appropriate solutions. Collaborates with product managers and engineers to develop specifications for new cloud-based products/services, applications and solutions. Drives the roll-out of cloud management platforms, evaluates its performance and implements enhancements. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Primary responsibilities to include: Design, implement, and maintain Genesys Cloud CX solutions, focusing on integration and deployment in a cloud environment. Monitor system performance, troubleshoot issues, and provide technical support and resolution for complex incidents related to the Genesys Cloud platform. Collaborate with cross-functional teams, including IT, management, and external vendors to ensure seamless functionality and scalability of the contact center systems. Provide support to end-users and management, empowering them to utilize the system features and capabilities effectively. Keep abreast of new trends and technologies in the contact center industry, specifically related to Genesys Cloud solutions and workforce optimization. Document all system configurations, updates, and procedures to ensure consistency and continuity across the platform. Manage contact center reporting and other related tasks. Use your skills to make an impact Required Qualifications Bachelor's degree in relevant field of study and 5+ years professional experience required, or equivalent combination of education and experience Genesys Cloud CX architecture and implementation experience Experience in multichannel Genesys applications (Voice, SMS, Chat, Video, and Email) including maintenance and support of Genesys Cloud, including Architect Flows, APIs, Data Actions, Outbound campaigns, call recording and speech/text analytics. 7 + years of Telecom engineering 3 + years of hands-on Genesys Cloud CX experience Experience working within Enterprise Contact Center Environments, call routing, and voice response. Experience with ticketing systems and change management Strong SIP protocol analysis skills and strong VoIP Understanding Genesys Cloud CX and AWS certifications are a strong plus Willingness and ability to work hours necessary to meet operational deadlines as needed. Preferred Qualifications Master's Degree Work-At-Home Requirements WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $106,900 - $147,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 06-19-2025 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

The Product Lead Analyst for Clinical Go to Market (GTM) Strategy will be responsible for the overall stewardship of each data product's GTM strategy. Forsyth will be continually developing data products to make available to existing and prospective clients, with an over index into clinical-specific data. This role will be responsible for supporting the leader of product growth and marketing in tracking and executing all GTM related deliverables prior to and after product launches. This role will need someone who has experience prioritizing and managing timelines and deliverables, is organized, task and deadline oriented, a good cross-functional partner, teachable in areas of opportunity, willing and ready to jump into ambiguity and define it and someone who is independent, strong communicator, self-starter and excited about delivering excellence to the market with a friendly and positive attitude. RESPONSIBILITIES: Product positioning/messaging and overall branding strategy Tracking/Executing Marketing/Sales campaigns Supporting Market/customer research (competitive intel, understand the buyer needs) Understanding a product's target audience (users)- who will use this product? Coordination across teams to understand how their delivery timelines effect GTM timelines Business Cases (where does our product fit into the product lifecycle of a given brand?) Use Cases (what are valuable ways they can use our product - examples of the how and what value it provides) Pricing and sales strategy coordination (involving key stakeholders and coordinating meetings to develop this information) Sales enablement (sales materials, presentations, talk-tracks, training, etc) Product launch planning (timelines, milestones, progress updates) Customer insight gathering (pre and post launch, if applicable), as well as feedback from internal stakeholders on client reactions to refine GTM approach or improve product IDEAL CANDIDATES WILL HAVE A COMBINATION OF THE FOLLOWING: 3-5 years of Marketing and/or branding experience preferred Pharma Industry experience a plus Exceptional verbal and written communication skills Working knowledge of Microsoft Office Suite, including Excel and PowerPoint High attention to detail and excellent organizational skills Strong project management skills Ability to learn and network internally Curiosity to learn and eagerness to expand knowledge and skill set Creative mindset with a passion to share ideas If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs and leads various advance analysis and interpretation to business activities for process improvements that will impact membership retention and overall STAR rating. Handles large and complex internal and external data initiatives, lead as subject matter expert in all things related to CMS voluntary disenrollment insights. Leads annual CMS STAR rating disenrollment compliant audits, providing examples of any gaps that could change our Medicare STAR rating by H-contract. Able to interpret and understand changes to voluntary disenrollment logics according to CMS requirements. Leads in the support of business initiatives through CMS STAR rating trend analysis via TRR, identification of membership reasons for disenrollment and recommend opportunities for process improvement in retention planning. Present findings in PowerPoint format for leadership. Provides advanced insight and dashboard development support for business leaderships in the following areas: CMS disenrollment (TRR, crosswalk, competitor directories), membership, sales channel, product type/space, regional/state level, H-contract/PBP level datasets with advance Excel, Tableau, and Power-BI tools. Provides development of annual STAR voluntary disenrollment rating forecast down to each PBP level to provide guidelines/resources needed to blend the curve and achieve higher STAR ranking for higher CMS bonus. Oversees training and mentoring other business and data analysts both internal and external to the team. Serve as the subject matter expert in all things related to CMS STAR rating disenrollment analysis. Education/Experience: Bachelor's degree in related field or equivalent experience. 8+ years of statistical analysis or data analysis experience. Healthcare experience preferred. Experience performing CMS Plan Finder “member choosing to leave plan” Star measure audit. Oversee training and mentoring other Business Analysts. Experience managing projects or heavy involvement in project implementation. Advance MS Excel and MS PowerPoint. Ability to understand SQL and SAS queries. Ability to modify Tableau/Power BI dashboards. Travel: Up to 5% nationwide and will require overnight stay. Pay Range: $86,000.00 - $154,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

McKesson requires new employees to be fully vaccinated for COVID-19 as defined by the CDC, subject to applicable, verified accommodation requests. McKesson is in the business of better health, and we touch the lives of patients in virtually every aspect of healthcare. We partner with payors, hospitals, physician offices, pharmacies, pharmaceutical companies, and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. We believe in the importance of strong, vital organizations because we know that patients can only be healthy when our system is healthy. Every single McKesson employee contributes to our mission-by joining McKesson you act as a catalyst in a chain of events that helps millions of people all over the globe. Talented, compassionate people are the future of our company-and of healthcare. At McKesson, you'll collaborate on the products and solutions that help us carry out our mission to improve lives and advance healthcare. Working here is your opportunity to shape an industry that's vital to us all. We understand the importance of a system that works together. Your expertise, drive and passion can help us improve everything we touch, from providers to payors to pharmacies. Join our team of leaders to begin a rewarding career. Wherever you contribute here at McKesson, you will have the ability to make a real impact in the lives of others. Job Description The state of healthcare is complex, but our shared purpose isn't: Help people get the medicine they need to live healthier lives. CoverMyMeds solves medication access challenges for patients throughout every step of their journey through a unified brand that now encompasses RelayHealth, RxCrossroads by McKesson, McKesson Prescription Automation and CoverMyMeds. Our combined experience spans nearly 90 years and together, we're applying our expertise to solve some of the biggest problems in healthcare. We accelerate innovative solutions for problems like medication affordability and adherence in way that everyone wins - from providers to pharmacies, payers to biopharma and, especially, patients. By combining automation and expert intervention, the company provides prior authorization, prescription decision support, specialty patient support, core adjudication network, patient assistance programs, clinical and behavioral adherence and patient empowerment solutions. We're proud to be an integral part of McKesson Corporation and embody the shared values and leadership behaviors of the greater organization. We understand the importance of a system that works together. Your expertise, drive and passion can help us carry out our mission to improve lives and advance healthcare. Overview To provide high quality service to patients, providers, pharmaceutical company representatives and healthcare service companies for specialty prescription drugs through the coordination of services and the collection of patient specific clinical data and interaction to ensure adherence to physician treatment program and drug regimen. Responsibilities Case management and/or case coordination experience essential for program protocols Follow up with physicians and patients for compliance and persistence in reference to treatment protocols Coordinate drug shipments and patient training between patients, physician offices and specialty pharmacies. Provide medical information to providers and patients for coordination of services mandated by program protocols. Patient advocacy and compassion. Ability to work independently and as part of a cohesive team. Other duties and responsibilities as assigned by supervisor. Internal/External Contact: The Clinical Adherence and Compliance Coordinator will be in regular contact with patients, physician offices, payers, and pharmaceutical company representatives. Qualifications Minimum Education: Vocational or technical training is required. Licensed Practical Nurse certification is required/ (LPN). Minimum Experience Required: LPN Certification required Recent grads are welcome to apply! Knowledge, Skills, and Abilities required (except where noted as preferred): Knowledge of Medical Terminology. Knowledge of HCPCS, CPT and ICD-9 coding. Strong organizational skills Skills and Abilities required (except where noted as preferred): Ability to express ideas clearly both written and oral communications. Ability to enter data correctly. Strong attention to detail and ability to handle multiple tasks well. Strong computer skills required; preferably Microsoft Word or Excel software applications. Data entry skills required. Ability to read and interpret documents such as safety rules and procedure manuals. Ability to write routine reports and correspondence. Ability to resolve problems independently. Ability to speak effectively before groups/customers or employees of an organization. Ability to carry out instructions furnished in written, oral or diagram form. Adaptable to changing priorities as needed. Physical Requirements: Mostly sedentary work. Ability to correctly input data into the computer. Able to communicate effectively with customers whether in person, on the telephone, or through correspondence. Environment: These job responsibilities are executed as part of a customer service call center. The position will be located in a fast-paced organization with the potential for a variety of unplanned activities to occur simultaneously. Equal Opportunity Employer: EO/Minorities/Females/Disabled/Veterans Location: Fully Remote All locations available (excluding CO) Career Level - IC-Professional - P1 Additional Information All your information will be kept confidential according to EEO guidelines.

Introduction Do you want to join an organization that invests in you as a(an) Collections Specialist? At Work from Home, you come first. HCA Healthcare has committed up to 300 million in programs to support our incredible team members over the course of three years. Schedule: * Full-time position that requires 1 mid / evening shift/per week/on a Monday, Tuesday, Wednesday, or Thursday 11am- 9pm CST * 1 Saturday per month Hours between 9:00 AM - 3:00 PM CST. * Location: Work from Home; must live within an HCA Hospital market area. Benefits Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: * Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. * Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. * Free counseling services and resources for emotional, physical and financial wellbeing * 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) * Employee Stock Purchase Plan with 10% off HCA Healthcare stock * Family support through fertility and family building benefits with Progyny and adoption assistance. * Referral services for child, elder and pet care, home and auto repair, event planning and more * Consumer discounts through Abenity and Consumer Discounts * Retirement readiness, rollover assistance services and preferred banking partnerships * Education assistance (tuition, student loan, certification support, dependent scholarships) * Colleague recognition program * Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) * Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated Collections Specialist like you to be a part of our team. Job Summary and Qualifications As a Patient Account Collections Specialist you will be responsible for outbound calls with account follow-up and resolution of patient receivables while providing excellent customer service. This position is work from home; must live within an HCA Healthcare hospital market area. Duties and Responsibilities: * Refer calls/accounts to appropriate parties based on customer inquiries. You will spend 90% of your day on the phone. * Identify problem accounts and escalate as appropriate. * Update the patient account record to identify actions taken on the account. * Work with patients and guarantors to secure payment on outstanding account balances. * Maintain minimum production standards. * Achieve passing quality review scores per unit requirements. * Produce acceptable unit collection volumes. * Work within company attendance guidelines. * Provide excellent customer service. * Work with other team members and management in a professional manner.? Qualifications: * High School Graduate or GED preferred * Previous Call Center experience preferred * Minimum one-year related experience preferred, preferably in healthcare. * Experience with collections in healthcare revenue space is preferred. * This is a work from home position that requires high-speed internet with 25 MB Download and 15 MB Upload. Wifi is not permitted. * Ability to work uninterrupted for shift (not including breaks/lunch) * BILINGUAL is not required, but a plus Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Collections Specialist opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

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 Pay Range: $18 - $29.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.