- Molina Healthcare (Dayton, OH)
- …Works with Legal and Corporate as needed to modify templates to ensure compliance with all contractual and/or regulatory requirements. + Oversees plan-specific ... or related field. **Required Experience** + 10+ years progressive experience in Healthcare Administration, Managed Care and/or Provider Services. + Experience… more
- Molina Healthcare (OH)
- …execute comprehensive Medicare strategies aligned with enterprise goals and regulatory requirements. + Design and implement state-specific and product-specific ... and retention. + Analyze market trends, competitive intelligence, and regulatory changes to inform strategic decisions. + Lead high-priority, cross-functional… more
- Molina Healthcare (OH)
- …other Molina departments as needed + Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings ... education and work experience. + 3 years' experience in healthcare with a minimum of 2 years' experience in...of 2 years' experience in health plan member interventions, managed care, or equivalent experience. + Demonstrated solid business… more
- Molina Healthcare (Cincinnati, OH)
- …appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) ... knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and… more
- Continuing Healthcare Solutions (Belpre, OH)
- …plan of care* + Schedule routine MDS assessments (initial, quarterly, annual) to maintain compliance with regulatory time frames* + Schedule ARD for all routine ... Medicare and Medicaid required documentation. + Responsible for Medicare and Managed Care determination and ongoing documentation of same including communication… more
- Molina Healthcare (Cleveland, OH)
- …that support continuous quality improvement of the provider database, compliance with regulatory /accreditation requirements, and Network Management business ... equivalent combination of education and experience **Required Experience** + 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider… more
- Molina Healthcare (Akron, OH)
- **JOB DESCRIPTION** **Job Summary** Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and ... management, and/or transition of care activities to assist Molina Healthcare members with their healthcare needs. Care...align with the model of care and that meet regulatory requirements. + Manages staff caseloads and assigns cases… more
- Molina Healthcare (Akron, OH)
- …and in compliance with all relevant federal, state, and local regulatory requirements. **Job Duties** + Leads and supports integrated duals overall business and ... + Coordinates accountabilities between duals office and shared service to drive compliance and efficiency as well as provide oversight, including service level… more
- Molina Healthcare (Dayton, OH)
- …or more direct report supervisors, facilitates integrated, proactive management, ensuring compliance with state and federal regulatory and accrediting standards. ... Education** Associate's or Bachelor's Degree **Preferred Experience** 3+ years of healthcare or health plan supervisory experience. Managed Care operations… more
- Molina Healthcare (Cincinnati, OH)
- …in-home assessment activities in all government lines of business impacted by the regulatory risk adjustment payment model. They will be assist with implementing and ... the in-home assessment program. **Knowledge/Skills/Abilities** This role interacts and supports regulatory agency policy and procedures by acting as a key business… more