12 Healthcare Positions jobs in Sioux City
Medical / Healthcare LPN
Le Mars, Iowa
Fusion Medical Staffing
Posted today
Job Viewed
Job Description
Travel LPN Company: Fusion Medical Staffing Location: Facility in Le Mars, Iowa Job Details Fusion Medical Staffing is seeking a skilled Licensed Practical Nurse for a 13-week travel assignment in Le Mars, Iowa. Required Qualifications: One year of recent experience as an LPN Valid LPN license in compliance with state regulations Current BLS (AHA/ARC) or CPR certification Preferred Qualifications: Other certifications may be required depending on facility requirements Summary: A Licensed Practical Nurse (LPN) provides hands-on nursing care to residents and/or patients, ensuring their medical and daily living needs are met with compassion and efficiency. LPNs monitor patient conditions, administer medications, assist with treatments, and collaborate with the healthcare team to promote residents' overall health and well-being. Provide bedside care to patients and assist with personal hygiene and activities of daily living Assist with wound care, catheter management, and other skilled nursing procedures Administer prescribed medications and treatments, following facility policies and state nursing regulations Document care provided and resident status accurately and in a timely manner Collaborate with RNs, CNAs, and healthcare providers to develop and follow individualized care plans Educate residents and families about medications, treatments, and disease management Support residents' emotional well-being, providing compassionate care and meaningful interactions Supervise CNAs and other support staff, delegating tasks appropriately Recognize and report changes in patient condition to RNs and healthcare provider team Respond to emergencies and implement appropriate interventions within the LPN scope of practice Perform other duties as assigned within the scope of practice Required Essential Skills: Critical thinking, service excellence, and good interpersonal communication skills The ability to read, write, and communicate in the English language Ability to read/comprehend written instructions, follow verbal instructions, and proficiency in PC skills Physical Abilities - Must be able to remain in a stationary position, move about, move equipment (50-100lbs), push, pull, and bend Interpersonal Skills - Must be able to work effectively with a variety of personnel (professional and ancillary) to present a positive attitude and professionalism Technical/Motor Skills - Must have the ability to grasp, perform fine manipulation, push/pull, and move about when assisting with procedures and/or using department equipment Mental Requirements - Must be able to cope with frequent contact with the general public and customers while meeting deadlines under pressure. Must be able to work under close supervision occasionally, as well as working without assistance from other personnel. Must be able to contend with irregular activity schedules occasionally and continuous concentration to detail Sensory - Must possess visual acuity and ability to effectively communicate Benefits Include: Highly competitive pay for travel professionals Comprehensive medical, dental, and vision insurance with first day coverage Paid Time Off (PTO) after 1560 hours Life and Short-term disability offered 401(k) matching Aggressive Refer-a-friend Bonus Program 24/7 recruiter support Reimbursement for licensure and CEUs Why Choose Fusion? At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch, and we're always looking for people like you to join our mission. Your passion for helping others deserves a partner just as committed to supporting you — that’s why we offer day one insurance, $0 copay for mental health services, scholarships and awards, exclusive discounts, and more. From your personal recruiter to our clinical and traveler experience teams, we’re here to guide and celebrate you along your journey. You take care of others; we take care of you. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Start your rewarding career as a Travel LPN with Fusion Medical Staffing and join our mission to improve lives. Fusion is an EOE/E-Verify Employer pb6
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0
Healthcare Services Operations Support Auditor
51101 Sioux City, Iowa
Molina Healthcare
Posted 1 day ago
Job Viewed
Job Description
JOB DESCRIPTION Job SummaryProvides support for non-clinical healthcare services auditing activities. Responsible for performing audits for non-clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
- Performs audits of non-clinical staff in utilization management, care management, member assessment, and/or other teams - monitoring for compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state and federal guidelines and requirements.
- Reports outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
- Ensures auditing approaches follow a Molina standard in approach and tool use.
- Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
- Demonstrates professionalism in all communications.
- Adheres to departmental standards, policies, protocols.
- Maintains detailed records of auditing results.
- Assists healthcare services with developing training materials or job aids as needed to address findings in audit results.
- Meets minimum production standards related to non-clinical auditing.
- May conduct staff trainings as needed.
- Communicates with quality, and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.
Required Qualifications
- At least 2 years health care experience, preferably in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
- Strong analytical and problem-solving skills.
- Ability to work in a cross-functional, professional environment.
- Ability to work on a team and independently.
- Excellent verbal and written communication skills.
- Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
- Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) non-clinical review/auditing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $24 - $56.17 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Essential Job Duties
- Performs audits of non-clinical staff in utilization management, care management, member assessment, and/or other teams - monitoring for compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state and federal guidelines and requirements.
- Reports outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
- Ensures auditing approaches follow a Molina standard in approach and tool use.
- Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
- Demonstrates professionalism in all communications.
- Adheres to departmental standards, policies, protocols.
- Maintains detailed records of auditing results.
- Assists healthcare services with developing training materials or job aids as needed to address findings in audit results.
- Meets minimum production standards related to non-clinical auditing.
- May conduct staff trainings as needed.
- Communicates with quality, and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.
Required Qualifications
- At least 2 years health care experience, preferably in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
- Strong analytical and problem-solving skills.
- Ability to work in a cross-functional, professional environment.
- Ability to work on a team and independently.
- Excellent verbal and written communication skills.
- Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
- Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) non-clinical review/auditing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $24 - $56.17 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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1
Healthcare Services Operations Support Auditor
51101 Sioux City, Iowa
Molina Healthcare
Posted 2 days ago
Job Viewed
Job Description
JOB DESCRIPTION
Job Summary
Provides support for non-clinical healthcare services auditing activities. Responsible for performing audits for non-clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
- Performs audits of non-clinical staff in utilization management, care management, member assessment, and/or other teams - monitoring for compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state and federal guidelines and requirements.
- Reports outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
- Ensures auditing approaches follow a Molina standard in approach and tool use.
- Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
- Demonstrates professionalism in all communications.
- Adheres to departmental standards, policies, protocols.
- Maintains detailed records of auditing results.
- Assists healthcare services with developing training materials or job aids as needed to address findings in audit results.
- Meets minimum production standards related to non-clinical auditing.
- May conduct staff trainings as needed.
- Communicates with quality, and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.
Required Qualifications
- At least 2 years health care experience, preferably in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
- Strong analytical and problem-solving skills.
- Ability to work in a cross-functional, professional environment.
- Ability to work on a team and independently.
- Excellent verbal and written communication skills.
- Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
- Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) non-clinical review/auditing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $24 - $56.17 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Job Summary
Provides support for non-clinical healthcare services auditing activities. Responsible for performing audits for non-clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
- Performs audits of non-clinical staff in utilization management, care management, member assessment, and/or other teams - monitoring for compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state and federal guidelines and requirements.
- Reports outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
- Ensures auditing approaches follow a Molina standard in approach and tool use.
- Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
- Demonstrates professionalism in all communications.
- Adheres to departmental standards, policies, protocols.
- Maintains detailed records of auditing results.
- Assists healthcare services with developing training materials or job aids as needed to address findings in audit results.
- Meets minimum production standards related to non-clinical auditing.
- May conduct staff trainings as needed.
- Communicates with quality, and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.
Required Qualifications
- At least 2 years health care experience, preferably in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
- Strong analytical and problem-solving skills.
- Ability to work in a cross-functional, professional environment.
- Ability to work on a team and independently.
- Excellent verbal and written communication skills.
- Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
- Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) non-clinical review/auditing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $24 - $56.17 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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2
Data Analyst (Healthcare Preferred) - Remote
51101 Sioux City, Iowa
Molina Healthcare
Posted 2 days ago
Job Viewed
Job Description
**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.
Pay Range: $77,969 - $116,835 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
Pay Range: $77,969 - $116,835 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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3
Analyst, Healthcare Ops - Remote GA
51101 Sioux City, Iowa
Molina Healthcare
Posted 2 days ago
Job Viewed
Job Description
**JOB DESCRIPTION**
***Candidate must reside in Georgia***
**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.
Molina Healthcare Core Competencies: Generally, the ability to understand, internalize, exhibit and promote behaviors that reflect Molina Healthcare's Core Values.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Helps to oversee development, organization, and ongoing maintenance of data representing a wide range of healthcare information.
+ Identifies and completes report enhancements/fixes.
+ Assists with completion of special projects as requested, by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.
+ Establishes and maintains timelines for reports and projects.
+ Generates and distributes weekly/monthly/quarterly/annually standard reports.
+ Must have experience in analyzing Utilization management, member health risk assessment data using SQL, Databricks and create reports using PowerBI
+ Must be able to collaborate with Executive teams in Utilization management, Operations, Core EIM teams.
**JOB QUALIFICATIONS**
**Required Education**
Associate 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 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.
#PJHPO
Pay Range: $21.16 - $46.42 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
***Candidate must reside in Georgia***
**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.
Molina Healthcare Core Competencies: Generally, the ability to understand, internalize, exhibit and promote behaviors that reflect Molina Healthcare's Core Values.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Helps to oversee development, organization, and ongoing maintenance of data representing a wide range of healthcare information.
+ Identifies and completes report enhancements/fixes.
+ Assists with completion of special projects as requested, by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.
+ Establishes and maintains timelines for reports and projects.
+ Generates and distributes weekly/monthly/quarterly/annually standard reports.
+ Must have experience in analyzing Utilization management, member health risk assessment data using SQL, Databricks and create reports using PowerBI
+ Must be able to collaborate with Executive teams in Utilization management, Operations, Core EIM teams.
**JOB QUALIFICATIONS**
**Required Education**
Associate 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 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.
#PJHPO
Pay Range: $21.16 - $46.42 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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4
Program Manager, Healthcare Services - Clinical Systems
51101 Sioux City, Iowa
Molina Healthcare
Posted today
Job Viewed
Job Description
**Job Summary**
Provides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care.
**Essential Job Duties**
+ Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion.
+ Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to business needs.
+ Serves as a subject matter expert and leads healthcare services programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
+ Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate. - Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents.
**Required Qualifications**
+ At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience.
+ Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
+ Strong analytical and problem-solving skills.
+ Strong organizational and time-management skills.
+ Ability to work in a cross-functional, professional environment.
+ Experience working within applicable state, federal, and third-party regulations.
+ Strong verbal and written communication skills.
+ Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
**Preferred Qualifications**
+ Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
+ Leadership experience.
+ Medicaid/Medicare population experience.
+ Six sigma certification
+ Experience with Agile Methodology
+ Experience with Epic
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Provides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care.
**Essential Job Duties**
+ Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion.
+ Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to business needs.
+ Serves as a subject matter expert and leads healthcare services programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
+ Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate. - Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents.
**Required Qualifications**
+ At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience.
+ Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
+ Strong analytical and problem-solving skills.
+ Strong organizational and time-management skills.
+ Ability to work in a cross-functional, professional environment.
+ Experience working within applicable state, federal, and third-party regulations.
+ Strong verbal and written communication skills.
+ Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
**Preferred Qualifications**
+ Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
+ Leadership experience.
+ Medicaid/Medicare population experience.
+ Six sigma certification
+ Experience with Agile Methodology
+ Experience with Epic
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
View Now
5
Program Manager-Healthcare Enrollment Data (Remote)
51101 Sioux City, Iowa
Molina Healthcare
Posted 2 days ago
Job Viewed
Job Description
**JOB DESCRIPTION**
**Job Summary**
Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management.
**Job Duties**
+ Active collaborator with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion.
+ Plans and directs schedules as well as project budgets.
+ Monitors the project from inception through delivery.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to the business.
+ Leads and manages team in planning and executing business programs.
+ Serves as the subject matter expert in the functional area and leads programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed.
+ Works with operational leaders within the business to provide recommendations on opportunities for process improvements.
+ Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
+ Generate and distribute standard reports on schedule
+ SQL Experience
+ Root Cause Analysis
**JOB QUALIFICATIONS**
**REQUIRED EDUCATION** :
Bachelor's Degree or equivalent combination of education and experience.
**REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** :
+ 3-5 years of Program and/or Project management experience.
+ Operational Process Improvement experience.
+ Healthcare 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 Program and/or Project management experience.
- Managed Care experience.
- Experience working in a cross functional highly matrixed organization.
**PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** :
- PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification and/or comparable coursework desired.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**Job Summary**
Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management.
**Job Duties**
+ Active collaborator with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion.
+ Plans and directs schedules as well as project budgets.
+ Monitors the project from inception through delivery.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to the business.
+ Leads and manages team in planning and executing business programs.
+ Serves as the subject matter expert in the functional area and leads programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed.
+ Works with operational leaders within the business to provide recommendations on opportunities for process improvements.
+ Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
+ Generate and distribute standard reports on schedule
+ SQL Experience
+ Root Cause Analysis
**JOB QUALIFICATIONS**
**REQUIRED EDUCATION** :
Bachelor's Degree or equivalent combination of education and experience.
**REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** :
+ 3-5 years of Program and/or Project management experience.
+ Operational Process Improvement experience.
+ Healthcare 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 Program and/or Project management experience.
- Managed Care experience.
- Experience working in a cross functional highly matrixed organization.
**PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** :
- PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification and/or comparable coursework desired.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
View Now
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6
Manager, Healthcare Analytics - Health Plan Integration - Remote
51101 Sioux City, Iowa
Molina Healthcare
Posted 2 days ago
Job Viewed
Job Description
**JOB DESCRIPTION**
**Job Summary**
Collects, validates, analyzes, and organizes data into meaningful reports for management decision making as well as designing, developing, testing, and deploying reports to provider networks and other end users for operational and strategic analysis.
**KNOWLEDGE/SKILLS/ABILITIES**
Manages and provides direct oversight of Healthcare Analytics Team activities and personnel. Provides technical expertise, manages relationships with operational leaders and staff. Directs staff assigned to their projects, maintains internal work plans as well as project work plans to meet reporting needs of the Health Plan. Resource to HCS staff for mentoring, coaching, and analysis questions. Responsible for staff time keeping, performance coaching, development, and career paths.
+ Daily management of Healthcare Analytics team.
+ Allocate new report/project requests (workload distribution).
+ Coordinates with Health Plan departments to meet data analysis and database development needs.
+ Reviews, evaluates, and improved Company business logic and data sources.
+ Resource to Health Plan staff for mentoring, coaching, and analysis questions.
+ Reviews Health Plan analyst work products to ensure accuracy and clarity.
+ Reviews regulatory reporting requirements and Health Plan project documentation.
+ Maintains reporting service level benchmarks for Healthcare Analytics team.
+ Represents Healthcare Analytics department in cross-departmental and operational meetings.
+ Serves as liaison between Corporate IT and Health Plan regarding reporting needs.
+ Creates reporting for strategic analysis, profitability, financial analysis, utilization patterns and medical management.
+ Interfaces and maintains positive interactions with Health Plan and Corporate personnel.
+ Management Health Plan Encounter workflow process.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field
**Required Experience**
+ 3 years management or team leadership experience
+ 10 years' work experience preferable in claims processing environment and/or healthcare environment
+ Strong knowledge of SQL 2005/2008 SSRS report development
+ Familiar with relational database concepts, and SDLC concepts
**Preferred Education**
Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field.
**Preferred Experience**
3 - 5 years supervisory experience
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $88,453 - $206,981 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**Job Summary**
Collects, validates, analyzes, and organizes data into meaningful reports for management decision making as well as designing, developing, testing, and deploying reports to provider networks and other end users for operational and strategic analysis.
**KNOWLEDGE/SKILLS/ABILITIES**
Manages and provides direct oversight of Healthcare Analytics Team activities and personnel. Provides technical expertise, manages relationships with operational leaders and staff. Directs staff assigned to their projects, maintains internal work plans as well as project work plans to meet reporting needs of the Health Plan. Resource to HCS staff for mentoring, coaching, and analysis questions. Responsible for staff time keeping, performance coaching, development, and career paths.
+ Daily management of Healthcare Analytics team.
+ Allocate new report/project requests (workload distribution).
+ Coordinates with Health Plan departments to meet data analysis and database development needs.
+ Reviews, evaluates, and improved Company business logic and data sources.
+ Resource to Health Plan staff for mentoring, coaching, and analysis questions.
+ Reviews Health Plan analyst work products to ensure accuracy and clarity.
+ Reviews regulatory reporting requirements and Health Plan project documentation.
+ Maintains reporting service level benchmarks for Healthcare Analytics team.
+ Represents Healthcare Analytics department in cross-departmental and operational meetings.
+ Serves as liaison between Corporate IT and Health Plan regarding reporting needs.
+ Creates reporting for strategic analysis, profitability, financial analysis, utilization patterns and medical management.
+ Interfaces and maintains positive interactions with Health Plan and Corporate personnel.
+ Management Health Plan Encounter workflow process.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field
**Required Experience**
+ 3 years management or team leadership experience
+ 10 years' work experience preferable in claims processing environment and/or healthcare environment
+ Strong knowledge of SQL 2005/2008 SSRS report development
+ Familiar with relational database concepts, and SDLC concepts
**Preferred Education**
Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field.
**Preferred Experience**
3 - 5 years supervisory experience
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $88,453 - $206,981 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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7
Specialist, Config Oversight (healthcare Medical claim audits)
51101 Sioux City, Iowa
Molina Healthcare
Posted 2 days ago
Job Viewed
Job Description
**Job Description**
**Work hours will be 7am-3:30pm PST M-F**
**Job Summary**
Responsible for conducting various healthcare Healthcare claim audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains to contracting (benefit and provider), network management, credentialing, prior authorizations, fee schedules, and other business requirements critical to claim accuracy. Maintain audit records, and provide counsel regarding coverage amount and benefit interpretation within the audit process. Provide clear and concise results and comments to leaders about focal audits. Contributes to completion of audits as needed to ensure audits are conducted in a timely fashion and in accordance with audit standards.
**Job Duties**
- Reviews documentation regarding updates/changes to member enrollment, provider contract, provider demographic information, and/or claim processing guidelines. Evaluates the accuracy of these updates/changes as applied to the appropriate modules within the core processing system (QNXT).
- Conducts focal healthcare Medical claim audits on samples of processed transactions impacted by these updates/changes. Determines that all outcomes are aligned to the original documentation and allow appropriate processing.
- Conducts audits of vendor audits and verifies accuracy of their published outcomes are aligned to the documentation, various sources of truth and being assessed appropriately.
- Clearly documents the focal audit results and makes recommendations as necessary.
- Researches and tracks the status of unresolved errors issued on daily transactional audits and communicates with Core Operations Functional Business Partners to ensure resolution within 30 days of error issuance.
- Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims. ( _Use for claims specific positions only_ )
- Prepares, tracks and provides audit findings reports according to designated timelines
- Presents audit findings and makes recommendations to management for improvements based on audit results.
**Job Qualifications**
**REQUIRED EDUCATION:**
Associate's Degree or equivalent combination of education and experience
**REQUIRED EXPERIENCE, SKILLS & ABILIITIES:**
+ Minimum 2 years as an operational auditor for at least one core operations function
+ Previous examiner/processing experience in at least one core operations functional area
+ Strong attention to detail
+ Knowledge of using Microsoft applications to include; Excel, Word, Outlook, Powerpoint and Teams
+ Ability to effectively communicate written and verbal
+ Knowledge of verifying documentation related to updates/changes within claims processing system .
+ Experience using claims processing system (QNXT).
**PREFERRED EDUCATION:**
Bachelor's Degree or equivalent combination of education and experience
**PREFERRED EXPERIENCE:**
3+ years healthcare Medical claims auditing
**PHYSICAL DEMANDS:**
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
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: $21.16 - $42.2 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**Work hours will be 7am-3:30pm PST M-F**
**Job Summary**
Responsible for conducting various healthcare Healthcare claim audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains to contracting (benefit and provider), network management, credentialing, prior authorizations, fee schedules, and other business requirements critical to claim accuracy. Maintain audit records, and provide counsel regarding coverage amount and benefit interpretation within the audit process. Provide clear and concise results and comments to leaders about focal audits. Contributes to completion of audits as needed to ensure audits are conducted in a timely fashion and in accordance with audit standards.
**Job Duties**
- Reviews documentation regarding updates/changes to member enrollment, provider contract, provider demographic information, and/or claim processing guidelines. Evaluates the accuracy of these updates/changes as applied to the appropriate modules within the core processing system (QNXT).
- Conducts focal healthcare Medical claim audits on samples of processed transactions impacted by these updates/changes. Determines that all outcomes are aligned to the original documentation and allow appropriate processing.
- Conducts audits of vendor audits and verifies accuracy of their published outcomes are aligned to the documentation, various sources of truth and being assessed appropriately.
- Clearly documents the focal audit results and makes recommendations as necessary.
- Researches and tracks the status of unresolved errors issued on daily transactional audits and communicates with Core Operations Functional Business Partners to ensure resolution within 30 days of error issuance.
- Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims. ( _Use for claims specific positions only_ )
- Prepares, tracks and provides audit findings reports according to designated timelines
- Presents audit findings and makes recommendations to management for improvements based on audit results.
**Job Qualifications**
**REQUIRED EDUCATION:**
Associate's Degree or equivalent combination of education and experience
**REQUIRED EXPERIENCE, SKILLS & ABILIITIES:**
+ Minimum 2 years as an operational auditor for at least one core operations function
+ Previous examiner/processing experience in at least one core operations functional area
+ Strong attention to detail
+ Knowledge of using Microsoft applications to include; Excel, Word, Outlook, Powerpoint and Teams
+ Ability to effectively communicate written and verbal
+ Knowledge of verifying documentation related to updates/changes within claims processing system .
+ Experience using claims processing system (QNXT).
**PREFERRED EDUCATION:**
Bachelor's Degree or equivalent combination of education and experience
**PREFERRED EXPERIENCE:**
3+ years healthcare Medical claims auditing
**PHYSICAL DEMANDS:**
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
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: $21.16 - $42.2 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
View Now
8