17 Healthcare jobs in Morgantown

**JOB DESCRIPTION**
**Job Summary**
Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
**KNOWLEDGE/SKILLS/ABILITIES**
The VP, Healthcare Services is responsible for oversight and management of the state health plan's Healthcare Services (clinical operations) teams including Utilization Management (prior-authorization, inpatient review) and Care Management (case/health management and transition of care). This position works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets.
+ Works with the Healthcare Services management team to achieve successful implementation of Molina clinical strategy and direction.
+ Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operations functions and promote quality cost effective health care for Molina members.
+ Mentors, guides, and develops skills of management team members in a consistent and effective manner.
+ Develops initiatives to achieve budgeted reductions in medical expenses and increases in quality scores.
+ Develops Healthcare Services department budget and ensures budget targets are met.
+ Manages implementation of analytical studies that quantify the benefits of Healthcare Services programs to ensure that resources are appropriately allocated, operational controls exist, and efficiencies are maximized.
+ Facilitates integration of care coordination, long term care, behavioral health, and chemical dependency programs.
+ Continually refines operational processes and champions review of team processes, workflows, and activities.
+ Articulates project requirements and anticipated outcomes to the Molina Project Management Office for identified projects/strategies to improve the efficiency of clinical operations teams to meet cost and quality goals.
+ Accountable for ensuring compliance with contractual, accreditation and regulatory requirements for all Healthcare Services teams.
+ Participates personally or assigns appropriate staff to Molina Quality Committees and external Community Committees to represent the Healthcare Services department.
+ Ensures effective inter-departmental collaboration and interaction between Healthcare Services staff and other departments.
+ Ensures monthly auditing of HCS staff is performed and appropriate actions and/or coaching occur.
+ Responsible for oversight of clinical training activities and outcomes.
+ Responsible for HCS-related delegation oversight monitoring.
**JOB QUALIFICATIONS**
**Required Education**
Master's Degree or equivalent combination of education and work experience.
**Required Experience**
+ 10 years managed care experience with line management responsibility including clinical operations.
+ Experience working within applicable state, federal, and third-party regulations.
+ Operational and process improvement experience.
+ Strong communication and teaming/interpersonal skills.
+ Strong leadership capabilities and ability to initiate and maintain cross-team relationships.
+ Demonstrated experience meeting Quality Accreditation Standards (NCQA/HEDIS/STARS).
**Required License, Certification, Association**
If licensed, license must be active, unrestricted and in good standing.
**Preferred Education**
Master's Degree in Business or Healthcare management (i.e. MBA, MHA, MPH).
**Preferred Experience**
Familiarity and experience in the local market desirable.
**Preferred License, Certification, Association**
+ Active, unrestricted State Registered Nursing (RN) license in good standing.
+ Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification
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: $161,914.25 - $315,733 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**Job Description**
**Job Summary**
Responsible for all the aspects of architecture, design and implementation of Data Management solution using Big Data platform on Cloudera or Hortonworks and other areas of enterprise application platforms.
**Knowledge/Skills/Abilities**
- Convert concepts to technical architecture, design and implementation
- Provide guidance on choosing ideal Architecture, Evaluating tools and Frameworks, define Standards & Best Practices for implementing scalable business solutions
- Implement Batch and Real-time data ingestion/extraction processes through ETL, Streaming, API, etc., between diverse source and target systems with structured and unstructured datasets
- Design and build data solutions with an emphasis on performance, scalability, and high-reliability
- Code, test, and document new or modified data systems to create robust and scalable applications for data analytics
- Build data model for analytics and application layers
- Contribute to leading and building a team of top-performing data technology professionals
- Help with project planning and scheduling
- Expert level experience on Hadoop cluster components and services (like HDFS, YARN, ZOOKEEPER, AMBARI/CLOUDERA MANAGER, SENTRY/RANGER, KERBEROS, etc.)
- Ability to participate and lead, in solving technical issues while engaged with infrastructure and vendor support teams.
**Job Qualifications**
**Required Education**
Bachelor's Degree
**Required Experience**
- 5-7 years of data management experience.
- Experience in building stream-processing systems, using solutions such as Kafka, Storm or Spark-Streaming.
- Proven experience on Big Data tools such as, Spark, Hive, Impala, Polybase, Phoenix, Presto, Kylin, etc.
- Experience with integration of data from multiple data sources (using ETL tool such, Talend, etc.).
- Experience building solutions with NoSQL databases, such as HBase, Memsql.
- Strong experience on Database technologies, Data Warehouse, Data Validation & Certification, Data Quality, Metadata Management and Data Governance.
- Experience with programming language such as, Java/Scala/Python, etc.
- Experience implementing Web application and Web Services APIs (REST/SOAP).
**Preferred Education**
Master's Degree
**Preferred Experience**
- 7-10 years of data management experience.
- Experience in the healthcare industry is 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: $88,453 - $206,981 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**JOB DESCRIPTION**
**JOB DESCRIPTION**
**Job Summary**
The Senior Analyst, Healthcare plays a critical role in supporting clinical and operational initiatives by translating healthcare business needs into technical solutions. This role works closely with clinicians, utilization management teams, and business stakeholders to gather requirements and deliver actionable insights through data analytics. The ideal candidate brings a strong foundation in SQL, Power BI, Databricks, Snowflake, and ETL development, along with a collaborative approach to building scalable, healthcare-focused data solutions.
**KNOWLEDGE/SKILLS/ABILITIES**
- Partner with clinical, operational, and business teams to understand data needs and translate requirements into actionable technical solutions.
- Write advanced SQL queries to extract, validate, and analyze healthcare data, including claims, authorization, pharmacy, and lab datasets.
- Build and maintain efficient ETL pipelines to support ongoing reporting and analytics workflows.
- Utilize Databricks and Snowflake to develop scalable data pipelines and analytical datasets.
- Create and maintain Power BI dashboards to deliver insights on utilization, outcomes, and cost drivers across the organization.
- Ensure data quality, governance, and documentation standards are met in all analytics work.
- Support ad hoc data requests and collaborate cross-functionally to drive data-informed decisions in clinical and business operations.
- Maintain fluency in healthcare data types (e.g., ICD/CPT codes, HEDIS measures, member eligibility) to guide technical decisions.
**JOB QUALIFICATIONS**
**Required Education**
- Bachelor's or Associate's degree in Data Science, Computer Science, Analytics, Information Systems, Engineering, or other technology-related fields
**Required Experience**
+ 3-5 years of experience working with **healthcare data** in an analytics or data engineering capacity
+ Advanced proficiency in **SQL** for large dataset analysis and transformation
+ Experience using **Power BI** for developing interactive dashboards and data visualizations
+ Hands-on experience with **Databricks** , **Snowflake** , or enterprise **cloud data platforms**
+ Solid understanding of **ETL concepts** and experience building pipelines for healthcare analytics
+ Strong communication and collaboration skills to work with clinical and business stakeholders
**Preferred Experience**
+ 4+ years in a healthcare analytics role supporting **utilization management, population health, or quality improvement**
+ Experience working directly with **clinicians, nurses, or case management teams**
+ Familiarity with risk adjustment, value-based care models, or healthcare performance metrics
+ Understanding of regulatory and compliance considerations (e.g., HIPAA) in data handling
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 Description**
**Job Summary**
Responsible for conducting various 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 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 Claims Adjudication
**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.

**JOB DESCRIPTION**
**Job Summary**
This Sr. Analyst, Healthcare Analytics role will support Molina's Risk Adjustment Analytics team. The job responsibilities include developing risk score reporting with Databricks and Power BI, organizing and managing large and varied data sets, analyzing healthcare data for decision support, and communicating findings. Qualified candidates are the diligent problem solvers who have Databricks experience with advanced skills in data analysis. Performs research and deep-dive analysis of complex healthcare claims data, CMS return files, and financial cost, revenue, and vendor data. Collaborates with actuarial and operational staff to analyze, understand, modify, and communicate models and results. Makes recommendations to management based on relevant findings. Utilizes Power BI to display relevant reporting within a refresh cycle.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Compile and organize health care data using Databricks and Spark SQL programming, Notebooks, Workflows, Repositories, and other analytic / programming processes as needed.
+ Collect programming specifications from requestors to develop Notebooks, Workflows, and Power BI reporting using multiple data sources, crosswalks, and built-in validation checks.
+ Use peer-to-peer review process and end-user consultation to reduce errors and rework.
+ Assist with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps.
+ Must have a strong attention to detail and knowledge of data structure and programming.
+ Understanding data storage and data sharing methods.
+ Converting data into usable information that is easy to understand.
+ Research and develop reports and analysis for senior management and effectively communicate results.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Computer Science
**Required Experience**
+ 5-7 years increasingly complex database and data management responsibilities
+ 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics
+ Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare
+ Advanced knowledge of Databricks
+ Bachelor's Degree in Finance, Economics, Math, or Computer Science
**Preferred Experience**
Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:
+ Experience developing queries within project management tools like Azure DevOps.
+ Risk Adjustment experience and some familiarity with Power BI level report building, leveraging PBI to develop business insights.
+ Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.
+ Analysis and forecasting of trends to provide analytic support for finance, pricing and actuarial functions.
+ Healthcare Analyst I experience desired.
+ PowerBI, Excel, Power Pivot, VBA, Macros, Copilot
+ Python, PySpark, R, SAS, or other programming language(s)
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 DESCRIPTION**
**Job Summary**
JOB SUMMARY:
The Sr. Analyst, Healthcare plays a critical role in supporting clinical and operational initiatives by translating healthcare business needs into technical solutions. This role works closely with clinicians, care management teams, and business stakeholders to gather requirements and deliver actionable insights through data analytics. The ideal candidate brings a strong foundation in SQL, Power BI, Databricks, Snowflake, and ETL development, along with a collaborative approach to building scalable, healthcare-focused data solutions.
JOB DUTIES:
+ Partner with clinical, operational, and business teams to understand data needs and translate requirements into actionable technical solutions.
+ Write advanced SQL queries to extract, validate, and analyze healthcare data, including claims, pharmacy, and lab datasets.
+ Build and maintain efficient ETL pipelines to support ongoing reporting and analytics workflows.
+ Utilize Databricks and Snowflake to develop scalable data pipelines and analytical datasets.
+ Create and maintain Power BI dashboards to deliver insights on utilization, outcomes, and cost drivers across the organization.
+ Ensure data quality, governance, and documentation standards are met in all analytics work.
+ Support ad hoc data requests and collaborate cross-functionally to drive data-informed decisions in clinical and business operations.
+ Maintain fluency in healthcare data types (e.g., ICD/CPT codes, HEDIS measures, member eligibility) to guide technical decisions.
REQUIRED EDUCATION:
+ Bachelor's or Associate's degree in Data Science, Computer Science, Analytics, Information Systems, Engineering, or other technology-related fields
**REQUIRED EXPERIENCE / SKILLS:**
+ 3-5 years of experience working with **healthcare data** in an analytics or data engineering capacity
+ Advanced proficiency in **SQL** for large dataset analysis and transformation
+ Experience using **Power BI** for developing interactive dashboards and data visualizations
+ Hands-on experience with **Databricks** , **Snowflake** , or enterprise **cloud data platforms**
+ Solid understanding of **ETL concepts** and experience building pipelines for healthcare analytics
+ Strong communication and collaboration skills to work with clinical and business stakeholders
**PREFERRED EXPERIENCE:**
+ 4+ years in a healthcare analytics role supporting **care management, population health, or quality improvement**
+ Experience working directly with **clinicians, nurses, or case management teams**
+ Familiarity with risk adjustment, value-based care models, or healthcare performance metrics
+ Understanding of regulatory and compliance considerations (e.g., HIPAA) in data handling
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 DESCRIPTION**
**Job Summary**
This Sr. Analyst, Healthcare Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare intervention program performance. Develops and presents Risk Adjustment intervention ROI, incremental conditions captured, and other program performance reports including forecasts and makes recommendations based on relevant findings. Performs Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items (SAIs) to meet business needs. Performs analysis across multiple states and lines of business (Medicare, Medicaid, Marketplace ACA).
**KNOWLEDGE/SKILLS/ABILITIES**
+ Compiling and organizing health care data using Databricks and Spark SQL, Notebooks, Workflows, Repositories, SQL Server Stored Procedures, SQL Server Integration Services (SSIS), and other analytic / programming tools as needed
+ Reporting includes Risk Adjustment program performance metrics, risk score and revenue impact, tracking of strategic/scorable action items, annual and quarterly forecasts, and regular deep dives to drive improvement in financial results
+ Take ownership with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps
+ Create databases and reporting dashboards for monitoring, tracking and trending based on project specifications and applies automation as appropriate
+ Complete analysis and forecasting of risk adjustment intervention program values
+ Develop and demonstrate proficiency in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS model for Medicaid members, and others as needed
+ Must have a strong attention to detail and knowledge of data structure and programming
+ Performing financial analysis to assist in delivering optimal health care management and decision making
+ Understanding and applying data storage and data sharing best practices
+ Converting data into usable information that is easy to understand and provides insights needed to support strategic investment decisions
+ Research and develop reports and analyses for senior management and effectively and concisely communicate results and key takeaways
+ Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce errors and rework
+ Practice strong judgement in carrying out work independently, consult with experts as needed and use available resources and reports to critique results
+ Manage multiple projects and consistently deliver results on time in a fast-paced environment with changing priorities
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Computer Science
**Required Experience**
+ 5-7 years increasingly complex database and data management responsibilities
+ 5-7 years of increasingly complex experience in quantifying, measuring, analyzing, and reporting financial/performance management metrics
+ Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare
+ Advanced knowledge of SQL
+ Proficient in Excel and visualization tools such as Power BI, Tableau, or similar
**Preferred Experience**
Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:
+ Proactively identify and investigate complex suspect areas regarding risk adjustment initiatives, risk score lift, conditions captured, and program value
+ Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan
+ Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.
+ Analysis and forecasting of program value and underlying population trends in risk adjustment to provide analytic support for finance, pricing and actuarial functions
+ Healthcare Analyst I or Financial/Accounting Analyst I experience desired
+ Multiple data systems and models
+ Data modelling and BI tools
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCorp
#LI-AC1
Pay Range: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.