What Jobs are available for Healthcare Professionals in Albuquerque?
Showing 21 Healthcare Professionals jobs in Albuquerque
Healthcare Analytics Consultant
87190 Albuquerque, New Mexico
Health Care Service Corporation
Posted 2 days ago
Job Viewed
Job Description
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
**Job Summary**
The Consultant's primary responsibility is to leverage strong technical skills and healthcare industry knowledge to support clinical and business stakeholders. This role will be accountable for the analytical support and consultancy of internal/external customers, as well as advisory service for internal/external senior leaders.
**Required Job Qualifications:**
+ Bachelor's degree and 2 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR Master's degree in related field OR 6 years of experience in health care services, statistical analysis, or insurance industry economics or related field
+ Understanding, and being highly proficient at querying a wide variety of internal and external data sources to get meaningful insights.
+ Performance excellence in computer languages, such as SQL, R, Python.
+ Ability to create a dynamic and visually engaging dashboard leveraging data visualization tools such as Tableau or Power BI.
+ High degree of business intelligence and understanding how to take a business case from inception to customer or partner execution.
+ Excellent communication and presentation skills.
+ Ability to work independently and as part of a team.
+ Performance excellence in championing initiatives and collaborating with multiple stakeholders to bring the initiative to life.
**Preferred Job Qualifications:**
+ Experience with project management methodologies.
+ Experience of Healthcare industry - payor, provider, pharmacy, public health, epidemiology, etc.
+ Experience with Medicare Part D and STARS
+ Experience with version control/collaborative tools, such as GitHub
+ Experience with automation tools, such as Alteryx.
**This is a Flex (Hybrid) role: 3 days in office; 2 days remote.**
**Sponsorship is not available.**
**Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!**
**Pay Transparency Statement:**
At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
**HCSC Employment Statement:**
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
**Base Pay Range**
$60,300.00 - $133,400.00
Exact compensation may vary based on skills, experience, and location.
**Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities.**
**Join our Talent Community. ( more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.
Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment.
HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.
If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at to request reasonable accommodations.
Please note that only **requests for accommodations in the application process** will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions.
Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas,
Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association
© Copyright 2025 Health Care Service Corporation. All Rights Reserved.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
**Job Summary**
The Consultant's primary responsibility is to leverage strong technical skills and healthcare industry knowledge to support clinical and business stakeholders. This role will be accountable for the analytical support and consultancy of internal/external customers, as well as advisory service for internal/external senior leaders.
**Required Job Qualifications:**
+ Bachelor's degree and 2 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR Master's degree in related field OR 6 years of experience in health care services, statistical analysis, or insurance industry economics or related field
+ Understanding, and being highly proficient at querying a wide variety of internal and external data sources to get meaningful insights.
+ Performance excellence in computer languages, such as SQL, R, Python.
+ Ability to create a dynamic and visually engaging dashboard leveraging data visualization tools such as Tableau or Power BI.
+ High degree of business intelligence and understanding how to take a business case from inception to customer or partner execution.
+ Excellent communication and presentation skills.
+ Ability to work independently and as part of a team.
+ Performance excellence in championing initiatives and collaborating with multiple stakeholders to bring the initiative to life.
**Preferred Job Qualifications:**
+ Experience with project management methodologies.
+ Experience of Healthcare industry - payor, provider, pharmacy, public health, epidemiology, etc.
+ Experience with Medicare Part D and STARS
+ Experience with version control/collaborative tools, such as GitHub
+ Experience with automation tools, such as Alteryx.
**This is a Flex (Hybrid) role: 3 days in office; 2 days remote.**
**Sponsorship is not available.**
**Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!**
**Pay Transparency Statement:**
At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
**HCSC Employment Statement:**
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
**Base Pay Range**
$60,300.00 - $133,400.00
Exact compensation may vary based on skills, experience, and location.
**Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities.**
**Join our Talent Community. ( more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.
Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment.
HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.
If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at to request reasonable accommodations.
Please note that only **requests for accommodations in the application process** will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions.
Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas,
Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association
© Copyright 2025 Health Care Service Corporation. All Rights Reserved.
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0
Healthcare Collection Associate- Albuquerque, NM
87190 Albuquerque, New Mexico
IQVIA
Posted 18 days ago
Job Viewed
Job Description
**_We welcome you to apply if interested! You will be asked to create an account, which takes less than one minute and requires only a username and password. The entire application takes no more than 5-7 minutes to complete._**
**Position Description:**
Healthcare Associates will be responsible for collecting reprocessed medical equipment in a hospital. You will be working with surgical, non-invasive and vascular equipment within areas of the hospital such as Operating Rooms and Sterile Processing Departments. This is a great opportunity for you to gain medical experience!
You will have a flexible schedule Monday thru Friday - No evenings/No Weekends and an opportunity to grow and expand into new opportunities while earning supplemental income and learning about the medical device industry.
**Responsibilities:**
+ Visit assigned hospitals weekly to collect products to be reprocessed
+ Package and ship product to client manufacturing plant
+ Document and log daily collections totals
+ Notify the local Sales team of shipping supply needs
+ Appropriate PPE is provided to all employees prior to the start of assignments.
+ Commitment of 25 hours per week.
IQVIA takes the approach to helping customers drive healthcare forward in this challenging, fast-paced environment. We help customers accelerate results, improve patient outcomes, and unleash new opportunities.
**Job Requirements:**
+ An active and unrestricted driver license is required for this position
+ High school diploma or equivalent
+ Reliable vehicle for transportation
+ Must be comfortable with basic software programs and Microsoft operating system
+ Excellent customer service skills and strong attention to detail
+ Ability to lift 30-50 lbs
+ Duties may require compliance with client requirements that all those performing services on-site be fully vaccinated
Experience in healthcare, general labor, warehouse or customer service, is beneficial for this position. However, training is provided.
#LI-CES
#LI-DNP
IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable law. potential base pay range for this role is $25-$27 per hour. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.
IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create connections that accelerate the development and commercialization of innovative medical treatments. Everything we do is part of a journey to improve patient outcomes and population health worldwide.
To get there, we seek out diverse talent with curious minds and a relentless commitment to innovation and impact. No matter your role, everyone at IQVIA contributes to our shared goal of helping customers improve the lives of patients everywhere. Thank you for your interest in growing your career with us.
EEO Minorities/Females/Protected Veterans/Disabled
**Position Description:**
Healthcare Associates will be responsible for collecting reprocessed medical equipment in a hospital. You will be working with surgical, non-invasive and vascular equipment within areas of the hospital such as Operating Rooms and Sterile Processing Departments. This is a great opportunity for you to gain medical experience!
You will have a flexible schedule Monday thru Friday - No evenings/No Weekends and an opportunity to grow and expand into new opportunities while earning supplemental income and learning about the medical device industry.
**Responsibilities:**
+ Visit assigned hospitals weekly to collect products to be reprocessed
+ Package and ship product to client manufacturing plant
+ Document and log daily collections totals
+ Notify the local Sales team of shipping supply needs
+ Appropriate PPE is provided to all employees prior to the start of assignments.
+ Commitment of 25 hours per week.
IQVIA takes the approach to helping customers drive healthcare forward in this challenging, fast-paced environment. We help customers accelerate results, improve patient outcomes, and unleash new opportunities.
**Job Requirements:**
+ An active and unrestricted driver license is required for this position
+ High school diploma or equivalent
+ Reliable vehicle for transportation
+ Must be comfortable with basic software programs and Microsoft operating system
+ Excellent customer service skills and strong attention to detail
+ Ability to lift 30-50 lbs
+ Duties may require compliance with client requirements that all those performing services on-site be fully vaccinated
Experience in healthcare, general labor, warehouse or customer service, is beneficial for this position. However, training is provided.
#LI-CES
#LI-DNP
IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable law. potential base pay range for this role is $25-$27 per hour. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.
IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create connections that accelerate the development and commercialization of innovative medical treatments. Everything we do is part of a journey to improve patient outcomes and population health worldwide.
To get there, we seek out diverse talent with curious minds and a relentless commitment to innovation and impact. No matter your role, everyone at IQVIA contributes to our shared goal of helping customers improve the lives of patients everywhere. Thank you for your interest in growing your career with us.
EEO Minorities/Females/Protected Veterans/Disabled
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1
Data Analyst (Healthcare Preferred) - Remote
87190 Albuquerque, New Mexico
Molina Healthcare
Posted today
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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2
Healthcare Operations Intern (Reporting & Analytics) - REMOTE
87190 Albuquerque, New Mexico
Molina Healthcare
Posted 12 days ago
Job Viewed
Job Description
**JOB DESCRIPTION**
**Job Summary**
The Molina Healthcare Internship Program shares an objective to create a steppingstone for students who aim to be professionals and future leaders in the healthcare business profession. Interns are assigned special projects and various other duties that are intended to provide them with valuable professional work experience and industry insight. The purpose of an internship is to develop talent by providing students with experiential learning, formal training and opportunities to interact with healthcare professionals and community leaders. Interns will perform meaningful work alongside talented professionals, gaining insight to Molina's culture, Mission and Values.
**KNOWLEDGE, SKILLS & ABILITIES**
**Implementation Support:** Works to support management and teams through following job duties for implementation support:
+ Provides support with analytical, problem solving, including definition and documentation, business workflow analysis, specifications, requirements definition and documentation.
+ Supports documentation and changes to existing business processes. Helps to identify new opportunities for process developments and improvements.
+ Supports team on work plans and other deliverables for assigned areas utilizing approved templates and practices to ensure consistent content and format is maintained across department.
**Data Analytics:** Reviews data extracts from multiple sources of information and large data sets from a variety of systems to identify and analyze outliers.
+ Supports the work related to monitoring, tracking, and trending department data.
+ Supports preparation of state mandated reports and analysis.
**Preferred Experience**
+ Must possess clear and professional written, verbal and interpersonal communication skills.
+ Strong work ethic, self-motivated and ability to develop relationships.
+ Good time management, organizational and interpersonal skills required
+ Computer and data analysis experience including MS Word, Excel, Outlook and PowerPoint and experience with internet research.
+ Excellent critical thinking/problem solving skills
+ Ability to handle confidential information
+ Ability to maintain confidentiality and to comply with Health Insurance Portability and Accountability Act (HIPAA)
**REQUIRED EDUCATION:**
+ Must be currently enrolled in an undergraduate or graduate program
+ Should be a freshman sophomore or junior
+ Minimum GPA of 3.0 or higher
+ Pursuing a degree in - Data Analytics, Healthcare or related field
+ Must have unrestricted authorization to work in the United States
+ Able to commit to the full-time, 10-week internship program from June 1st - August 7, 2026.
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 - $21.66 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**Job Summary**
The Molina Healthcare Internship Program shares an objective to create a steppingstone for students who aim to be professionals and future leaders in the healthcare business profession. Interns are assigned special projects and various other duties that are intended to provide them with valuable professional work experience and industry insight. The purpose of an internship is to develop talent by providing students with experiential learning, formal training and opportunities to interact with healthcare professionals and community leaders. Interns will perform meaningful work alongside talented professionals, gaining insight to Molina's culture, Mission and Values.
**KNOWLEDGE, SKILLS & ABILITIES**
**Implementation Support:** Works to support management and teams through following job duties for implementation support:
+ Provides support with analytical, problem solving, including definition and documentation, business workflow analysis, specifications, requirements definition and documentation.
+ Supports documentation and changes to existing business processes. Helps to identify new opportunities for process developments and improvements.
+ Supports team on work plans and other deliverables for assigned areas utilizing approved templates and practices to ensure consistent content and format is maintained across department.
**Data Analytics:** Reviews data extracts from multiple sources of information and large data sets from a variety of systems to identify and analyze outliers.
+ Supports the work related to monitoring, tracking, and trending department data.
+ Supports preparation of state mandated reports and analysis.
**Preferred Experience**
+ Must possess clear and professional written, verbal and interpersonal communication skills.
+ Strong work ethic, self-motivated and ability to develop relationships.
+ Good time management, organizational and interpersonal skills required
+ Computer and data analysis experience including MS Word, Excel, Outlook and PowerPoint and experience with internet research.
+ Excellent critical thinking/problem solving skills
+ Ability to handle confidential information
+ Ability to maintain confidentiality and to comply with Health Insurance Portability and Accountability Act (HIPAA)
**REQUIRED EDUCATION:**
+ Must be currently enrolled in an undergraduate or graduate program
+ Should be a freshman sophomore or junior
+ Minimum GPA of 3.0 or higher
+ Pursuing a degree in - Data Analytics, Healthcare or related field
+ Must have unrestricted authorization to work in the United States
+ Able to commit to the full-time, 10-week internship program from June 1st - August 7, 2026.
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 - $21.66 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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3
Healthcare Business Admin Intern (Operations) - REMOTE
87190 Albuquerque, New Mexico
Molina Healthcare
Posted 12 days ago
Job Viewed
Job Description
**JOB DESCRIPTION**
**Job Summary**
The Molina Healthcare Internship Program shares an objective to create a steppingstone for students and alumni who aim to be professionals and future leaders in the healthcare business profession. We aim to develop talent by providing students and alumni with experiential learning, formal training, and opportunities to interact with healthcare business professionals who will act as intern managers along the way.
**KNOWLEDGE/SKILLS/ABILITIES**
· Assist in gathering and organizing operational data from various sources, including internal systems and reports.
· Conduct quantitative and qualitative analysis to identify trends, inefficiencies, and opportunities for improvement.
· Support the creation of dashboards, visualizations, and regular performance reports for leadership and operational teams.
· Collaborate with leadership and cross-functional teams to understand business processes and contribute to process optimization projects.
· Participate in meetings and present findings to team members and stakeholders.
· Help document processes, methodologies, and recommendations for future reference.
**Qualifications**
· Strong analytical and problem-solving skills, with attention to detail.
· Proficiency in Microsoft Excel; familiarity with data visualization tools (e.g., Power BI) is a plus.
· Excellent written and verbal communication skills.
· Ability to work independently and as part of a team in a fast-paced environment.
· Interest in business operations, process improvement, and data-driven decision making.
** REQUIRED EDUCATION:**
Must be currently enrolled in an undergraduate or graduate program
Should be a freshman sophomore or junior
Minimum GPA of 3.0 or higher
Pursuing a degree in Business/Information Systems, Actuarial Sciences, Industrial Engineering or a related field
Must have unrestricted authorization to work in the United States
Able to commit to the full-time, 10-week internship program from June 1 - August 7, 2026
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 - $21.66 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**Job Summary**
The Molina Healthcare Internship Program shares an objective to create a steppingstone for students and alumni who aim to be professionals and future leaders in the healthcare business profession. We aim to develop talent by providing students and alumni with experiential learning, formal training, and opportunities to interact with healthcare business professionals who will act as intern managers along the way.
**KNOWLEDGE/SKILLS/ABILITIES**
· Assist in gathering and organizing operational data from various sources, including internal systems and reports.
· Conduct quantitative and qualitative analysis to identify trends, inefficiencies, and opportunities for improvement.
· Support the creation of dashboards, visualizations, and regular performance reports for leadership and operational teams.
· Collaborate with leadership and cross-functional teams to understand business processes and contribute to process optimization projects.
· Participate in meetings and present findings to team members and stakeholders.
· Help document processes, methodologies, and recommendations for future reference.
**Qualifications**
· Strong analytical and problem-solving skills, with attention to detail.
· Proficiency in Microsoft Excel; familiarity with data visualization tools (e.g., Power BI) is a plus.
· Excellent written and verbal communication skills.
· Ability to work independently and as part of a team in a fast-paced environment.
· Interest in business operations, process improvement, and data-driven decision making.
** REQUIRED EDUCATION:**
Must be currently enrolled in an undergraduate or graduate program
Should be a freshman sophomore or junior
Minimum GPA of 3.0 or higher
Pursuing a degree in Business/Information Systems, Actuarial Sciences, Industrial Engineering or a related field
Must have unrestricted authorization to work in the United States
Able to commit to the full-time, 10-week internship program from June 1 - August 7, 2026
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 - $21.66 / 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
87190 Albuquerque, New Mexico
Molina Healthcare
Posted 18 days ago
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.
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5
Supervisor, Healthcare Services; Care Management (Remote - GA)
87190 Albuquerque, New Mexico
Molina Healthcare
Posted today
Job Viewed
Job Description
This position will offer remote work flexibility, but the individual selected for the role must reside in Georgia.
JOB DESCRIPTION
Job Summary
Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
+ Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.
+ Functions as a "hands-on" supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.
+ Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.
+ Trains and supports team members to ensure high-risk, complex members are adequately supported.
+ Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.
+ Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
+ Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.
+ Local travel may be required (based upon state/contractual requirements).
Required Qualifications
+ At least 5 years health care experience, and at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. r equivalent combination of relevant education and experience.
+ Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). 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.
+ Ability to manage conflict and lead through change.
+ Operational and process improvement experience.
+ Strong written and verbal communication skills.
+ Working knowledge of Microsoft Office suite.
+ Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Preferred Qualifications
+ Registered Nurse (RN). License must be active and unrestricted in state of practice.
+ Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
+ Medicaid/Medicare population experience.
+ Clinical experience.
+ Supervisory/leadership 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
#PJHPO3
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 DESCRIPTION
Job Summary
Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
+ Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.
+ Functions as a "hands-on" supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.
+ Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.
+ Trains and supports team members to ensure high-risk, complex members are adequately supported.
+ Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.
+ Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
+ Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.
+ Local travel may be required (based upon state/contractual requirements).
Required Qualifications
+ At least 5 years health care experience, and at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. r equivalent combination of relevant education and experience.
+ Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). 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.
+ Ability to manage conflict and lead through change.
+ Operational and process improvement experience.
+ Strong written and verbal communication skills.
+ Working knowledge of Microsoft Office suite.
+ Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Preferred Qualifications
+ Registered Nurse (RN). License must be active and unrestricted in state of practice.
+ Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
+ Medicaid/Medicare population experience.
+ Clinical experience.
+ Supervisory/leadership 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
#PJHPO3
Pay Range: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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6
Manager, Healthcare Analytics - Health Plan Integration - Remote
87190 Albuquerque, New Mexico
Molina Healthcare
Posted 26 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.
Is this job a match or a miss?
View Now
7
Specialist, Config Oversight (healthcare Medical claim audits)
87190 Albuquerque, New Mexico
Molina Healthcare
Posted 8 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.
Is this job a match or a miss?
View Now
8
Program Manager, Healthcare Services (Must Reside in New Mexico)
87190 Albuquerque, New Mexico
Molina Healthcare
Posted 13 days ago
Job Viewed
Job Description
JOB DESCRIPTION Job SummaryProvides 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.
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: $73,102 - $142,549 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
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: $73,102 - $142,549 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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9