What Jobs are available for Healthcare in Omaha?

Showing 15 Healthcare jobs in Omaha

Lead Analyst, Healthcare Analytics- Managed care analytics & financial contracts

31906 Columbus, Georgia Molina Healthcare

Posted 3 days ago

Job Viewed

Tap Again To Close

Job Description

**JOB DESCRIPTION**
***Candidates must be located in California and work PST hours.***
**Job Summary**
Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Develops, implements, and uses software and systems to support the department's goals.
+ Develops and generates ad-hoc and standard reports using SQL programming, excel , Databricks and other analytic / programming tools.
+ Coordinates and oversees report generation by team members and distribution schedule to ensure timely delivery to customers, ensuring the highest quality on every project/request. Responsible for error resolution, follow up and performance metrics monitoring.
+ Provides peer review of critical reports and guidance on programming / logic improvements; provides guidance to team members in their analysis of data sets and trends using statistical tools and techniques to determine significance and relevance.
+ Applies process improvements for the team's methods of collecting and documenting report / programming requirements from requestors to ensure appropriate creation of reports and analyses while reducing rework.
+ Manage the creation of comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.
+ Create new databases and reporting tools for monitoring, tracking, and trending based on project specifications.
+ Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.
+ Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.
+ Maintains SharePoint Sites as needed, including training materials and documentation archives.
+ Demonstrate Healthcare experience in contract modeling, analyzing relevant Financial and Utilization Metrics of Healthcare.
+ Must be able to act as a liaison between Finance and Network Contracting as well as other external teams.
+ Must have experience in Financial modeling, identifying Utilization mgmt. trends and monitor pair mix.
+ Experience with Medicaid contract analytics is highly preferred.
+ Experience working on Managed care analytics and healthcare reimbursement models is required.
+ Must be able to work in a cross functional team.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Computer Science
**Required Experience**
+ 6+ years of progressive responsibilities in Data, Finance or Systems Analysis
+ Expert knowledge on SQL, PowerBI, Excel, Databricks or similar tools
**Preferred Education**
Bachelor's Degree in Finance, Economics, Math, Accounting or related fields
Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:
+ Proactively identify and investigate complex suspect areas regarding contract rate and related medical costs
+ 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, etc.
+ Analysis of trends in medical costs to provide analytic support for finance, pricing, and actuarial functions
+ Multiple data systems and models
+ BI tools (Power BI)
**Preferred License, Certification, Association**
QNXT or similar healthcare payer applications
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 - $171,058 / 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

Senior Analyst, Provider Data Management -SQL/QNXT - Remote

31906 Columbus, Georgia Molina Healthcare

Posted 3 days ago

Job Viewed

Tap Again To Close

Job Description

**JOB DESCRIPTION**
**Job Summary**
Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Generates data to support continuous quality of provider data and developing SOPs and/or BRDs.
+ Develops and maintains documentation and guidelines for all assigned areas of responsibility.
+ Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality.
+ Assists in planning and coordination of the claim payment system upgrades and releases, including development and execution of some test plans.
+ Participates in the implementation and conversion of new and existing health plans.
**JOB QUALIFICATIONS**
**Required Education**
+ Bachelor's Degree in business administration, healthcare management, or a related field; or equivalent combination of education and experience
**Required Experience**
+ 5-7 years of business analysis experience
+ Proficiency in data analysis tools and techniques, such as Excel or SQL
+ Excellent communication, presentation, and interpersonal skills, with the ability to interact effectively with stakeholders at all levels
**Preferred Experience**
+ 7-9 years of business analysis 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.
#PJCore
Pay Range: $77,969 - $141,371 / 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

Program Director, Value-Based Care (VBC) - REMOTE

31906 Columbus, Georgia Molina Healthcare

Posted 3 days ago

Job Viewed

Tap Again To Close

Job Description

**JOB DESCRIPTION**
**Job Summary**
Responsible for leading strategic programs that enable providers to succeed in value-based care (VBC) through enhanced capabilities, education, and infrastructure. This role focuses on equipping providers with the tools, training, data, and support needed to deliver high-quality, efficient care. Oversees initiatives that drive purpose-driven Joint Operating Committees (JOCs), bilateral data integration, and EMR access to improve collaboration and transparency. Develops and implements VBC training, analytics, and population health education programs to strengthen provider performance and patient outcomes. Builds and maintains long-term, holistic relationships with providers and stakeholders, ensuring alignment with organizational goals. Provides governance and oversight across operational and strategic portfolios, manages issue escalation, and partners with Corporate EPMO and IT to ensure seamless execution of initiatives.
**Key Responsibilities**
+ Lead programs focused on provider enablement, ensuring access to tools, training, and data for success in VBC models.
+ Design and implement VBC training programs, analytics, and population health education initiatives.
+ Oversee data integration efforts, including bilateral data feeds and EMR access for providers.
+ Facilitate purpose-driven JOCs to align stakeholders on goals, performance, and improvement strategies.
+ Build and maintain long-term, collaborative relationships with providers and internal teams to drive engagement and performance.
+ Provide governance and oversight for strategic and operational portfolios, ensuring alignment with organizational objectives.
+ Partner with Corporate EPMO and IT to ensure effective execution of programs and resolution of escalated issues.
+ Develop business case methodologies and support implementation of business strategies for VBC initiatives.
**Knowledge/Skills/Abilities**
+ Deep understanding of value-based care models, provider enablement strategies, and population health management.
+ Strong knowledge of data integration, EMR systems, and analytics for performance improvement.
+ Expertise in program and portfolio management methodologies and tools.
+ Ability to design and deliver training programs for providers and internal teams.
+ Exceptional communication, facilitation, and relationship-building skills.
+ Strategic thinker with strong problem-solving and decision-making abilities.
+ Comfortable presenting to C-level executives and influencing across all organizational levels.
+ Ability to manage multiple priorities and navigate ambiguity in a fast-paced environment.
**Job Qualifications**
**Required Education:**
Bachelor's degree or equivalent combination of education and experience
**Required Experience:**
7-9 years in program/project management, with experience in healthcare, value-based care, or provider enablement
**Preferred Education:**
Graduate Degree or equivalent combination of education and experience
**Preferred Experience:**
10+ years, including leadership roles in healthcare delivery, population health, or value-based care initiatives
**Preferred License, Certification, Association:**
CPHQ or equivalent
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $80,412 - $156,803 / 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

Transition of Care Coach (RN)

31906 Columbus, Georgia Molina Healthcare

Posted today

Job Viewed

Tap Again To Close

Job Description

**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**
+ Follows member throughout a 30-day program that starts at hospital admission and continues through transitions from the acute setting to other settings, including nursing facility placement and private home, with the goal of reduced readmissions.
+ Ensures safe and appropriate transitions by collaborating with hospital discharge planners, as well as with hospitalists, outpatient providers, facility staff, and family/support network, as needed or at the request of member.
+ Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required.
+ Works with participating ancillary providers, public agencies, or other service providers to make sure necessary services and equipment are in place for a safe transition.
+ Conducts face-to-face visits of all members while in the hospital and home visits of high-risk members post-discharge.
+ Coordinates care and reassesses member's needs using the Coleman Care Transitions Model recommended post-discharge timeline.
+ Educates and supports member focusing on seven primary areas (ToC Pillars): medication management, use of personal health record, follow up care, signs and symptoms of worsening condition, nutrition, functional needs and or Home and Community-based Services, and advance directives.
+ Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
+ Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
+ Facilitates interdisciplinary care team meetings and informal ICT collaboration.
+ RNs provide consultation, recommendations, and education as appropriate to non-RN case managers.
+ RNs are assigned cases with members who have complex medical conditions and medication regimens.
+ RNs will conduct medication reconciliation when needed.
**JOB QUALIFICATIONS**
**Required Education**
Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.
**Required Experience**
1-3 years hospital discharge planning or home health.
**Required License, Certification, Association**
+ Active, unrestricted State Registered Nursing (RN) license in good standing.
+ Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
**CALIFORNIA State Specific Requirements: Must be licensed currently for the state of California. California is not a compact state.**
**Preferred Education**
Bachelor's Degree in Nursing
**Preferred Experience**
3-5 years hospital discharge planning or home health.
**Preferred License, Certification, Association**
Active, unrestricted Transitions of Care Sub-Specialty Certification and/or Certified Case Manager (CCM)
***Work schedule :M - F Pacific Business Hours**
**Candidates can live anywhere in the USA but must work PACIFIC hours.**
**California or West Coast USA Residents preferred**
***Remote, no travel required.**
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: $30.37 - $51.49 / 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

Medical Director, Behavioral Health (TX/WA)

31906 Columbus, Georgia Molina Healthcare

Posted 3 days ago

Job Viewed

Tap Again To Close

Job Description

**JOB DESCRIPTION**
**Job Summary**
Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs.
**Knowledge/Skills/Abilities**
Provides Psychiatric leadership for utilization management and case management programs for mental health and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management policies and procedures to improve quality outcomes and decrease costs.
- Provide regional medical necessity reviews and cross coverage
- Standardizes UM practices and quality and financial goals across all LOBs
- Responds to BH-related RFP sections and review BH portions of state contracts
- Assist the BH MD lead trainers in the development of enterprise-wide teaching on psychiatric diagnoses and treatment
- Provides second level BH clinical reviews, BH peer reviews and appeals
- Supports BH committees for quality compliance.
- Implements clinical practice guidelines and medical necessity review criteria
- Tracks all clinical programs for BH quality compliance with NCQA and CMS
- Assists with the recruitment and orientation of new Psychiatric MDs
- Ensures all BH programs and policies are in line with industry standards and best practices
- Assists with new program implementation and supports the health plan in-source BH services
- Additional duties as assigned
**Job Qualifications**
**REQUIRED EDUCATION:**
- Doctorate Degree in Medicine (MD or DO) with Board Certification in Psychiatry
**REQUIRED EXPERIENCE:**
- 2 years previous experience as a Medical Director in clinical practice
- 3 years' experience in Utilization/Quality Program Management
- 2+ years HMO/Managed Care experience
- Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.
- Knowledge of applicable state, federal and third-party regulations
**Required License, Certification, Association**
Active and unrestricted State (TX) Medical License, free of sanctions from Medicaid or Medicare.
**Preferred Experience**
- Peer Review, medical policy/procedure development, provider contracting experience.
- Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.
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.
#PJHS
#LI-AC1
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.
Is this job a match or a miss?
View Now

Senior Abstractor, HEDIS/Quality Improvement (Remote)

31906 Columbus, Georgia Molina Healthcare

Posted 3 days ago

Job Viewed

Tap Again To Close

Job Description

**Job Description**
**Job Summary**
Molina's Quality Improvement Sr. Abstractor conducts data collection and abstraction of medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The abstraction team will meet chart abstraction productivity standards as well as minimum over read standards. Sr. Abstractors will also provide mentoring to entry level abstractors.
**Job Duties**
+ Performs the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review.
+ Participates in meetings with vendors for the medical record collection process.
+ As needed, may collects medical records and reports from provider offices, loads data into the HEDIS application, and compares the documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed.
+ Participates in scheduled meetings with the National Over read team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results.
+ Assists with projects and process improvement initiatives
+ Mentors entry level Abstractors
**Job Qualifications**
**REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:**
Bachelor's degree or equivalent experience
**REQU** **I** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E/KNOWLEDGE, SKILLS & ABILITIES:**
+ 3 years experience in healthcare Quality/HEDIS specific to medical record review and abstraction
+ Intermediate knowledge and understanding of HEDIS projects
**PR** **E** **FE** **R** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:**
+ At least 3 years of medical record abstraction experience
+ 3+ years managed care experience.
+ Advanced knowledge of HEDIS and NCQA
**PR** **E** **FE** **R** **RED L** **I** **C** **E** **N** **S** **E,** **C** **E** **R** **TI** **FI** **C** **A** **T** **I** **O** **N** **, AS** **S** **O** **C** **I** **A** **TI** **O** **N** **:**
Active RN license for the State(s) of employment
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: $21.82 - $42.55 / 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

Senior Representative, Provider Services

31906 Columbus, Georgia Molina Healthcare

Posted 3 days ago

Job Viewed

Tap Again To Close

Job Description

**JOB DESCRIPTION**
**Job Summary**
Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state, and local regulations. Provider Services staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for the provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Under general supervision, responsible for various provider services functions with an emphasis on working externally with the Plan's highest priority, high volume, strategic providers to educate, advocate and engage as valuable partners.
+ Requires an in-depth knowledge of provider services and contracting subject matter expertise.
+ Resolves complex provider issues that may cross departmental lines and involve Senior Leadership.
+ Serves as a subject matter expert for other departments.
+ Trains other Provider Services Representatives, as appropriate.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting.
**Required Experience**
+ 3 - 5 years customer service, provider service, or claims experience in a managed care setting.
+ 3-5 years' experience in managed healthcare administration and/or Provider Services.
+ 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc.
+ Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to; fee-for service, capitation, and various forms of risk, ASO, etc.
**Preferred Education**
Bachelor's or master's degree.
**Preferred Experience**
+ 5+ years' experience in managed healthcare administration and/or Provider Services.
+ 5+ years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc.
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.
Is this job a match or a miss?
View Now
Be The First To Know

About the latest Healthcare Jobs in Omaha !

Manager, Medical Economics (Medicaid) - REMOTE

31906 Columbus, Georgia Molina Healthcare

Posted 3 days ago

Job Viewed

Tap Again To Close

Job Description

**JOB DESCRIPTION**
**Job Summary**
The Manager, Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives improvement change by recommending actionable initiatives to C-level Suite executives to mitigate these trends.
Responsible for conducting complex analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities.
**KNOWLEDGE/SKILLS/ABILITIES**
Manages and provides direct oversight of Medical Economics Team activities and personnel. Provides technical expertise, manages relationships with operational leaders and staff. Directs staff assigned to their projects, supports health plan market(s) with trend analyses, finding scoreable action items (SAIs) and ad hoc analyses as requested. Responsible for staff time keeping, performance coaching, development, and career paths.
+ Extract and compile information from various systems to support executive decision-making
+ Mine and manage information from large data sources.
+ Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs.
+ Work with clinical, provider network and other personnel to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions.
+ Work with business owners to track key performance indicators of medical interventions
+ Perform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives
+ Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action plan
+ Draw actionable conclusions based on analyses performed, make recommendations through use of healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterprise
+ Analyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management
+ Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports
+ Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes
+ Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making
+ Support Financial Analysis projects related to medical cost reduction initiatives and budgeting same
+ Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results
+ Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Math, Healthcare Management, Computer Science, Information Systems, or related field
**Required Experience**
+ 3 years management or team leadership experience
+ 10 years analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
+ Strong Knowledge of SQL and PowerBI 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
+ Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans
+ Experience with Databricks
+ Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.)
+ Proficiency with Excel and SQL for retrieving specified information from data sources.
+ Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
+ Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form)
+ Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. - Understanding of value-based risk arrangements
+ Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare
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: $88,453 - $172,484 / 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

Program Manager (Credentialing)

31906 Columbus, Georgia Molina Healthcare

Posted 3 days ago

Job Viewed

Tap Again To Close

Job Description

**JOB DESCRIPTION**
**Job Summary**
Responsible for internal business projects and programs, including sanctions and exclusion monitoring of provider network and integration of credentialing operations for new markets and acquisitions, involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management.
**Job Duties**
+ Active collaborator with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion.
+ Plans and directs schedules as well as project budgets.
+ Monitors the project from inception through delivery.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to the business.
+ Leads and manages team in planning and executing business programs.
+ Serves as the subject matter expert in the functional area and leads programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed.
+ Works with operational leaders within the business to provide recommendations on opportunities for process improvements.
+ Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
+ Generate and distribute standard reports on schedule
**JOB QUALIFICATIONS**
**REQUIRED EDUCATION** :
Bachelor's Degree or equivalent combination of education and experience.
**REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** :
+ 3-5 years of Program and/or Project management experience.
+ Operational Process Improvement experience.
+ Healthcare experience.
+ Experience with Microsoft Project and Visio.
+ Excellent presentation and communication skills.
+ Experience partnering with different levels of leadership across the organization.
**PREFERRED EDUCATION** :
Graduate Degree or equivalent combination of education and experience.
**PREFERRED EXPERIENCE** :
- 5-7 years of Program and/or Project management experience.
- Managed Care credentialing experience.
- Experience working in a cross functional highly matrixed organization.
**PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** :
- CPCS Certification, PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification and/or comparable coursework desired.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Is this job a match or a miss?
View Now

Director, Provider Network Management & Analytics (Medicare) - REMOTE

31906 Columbus, Georgia Molina Healthcare

Posted 3 days ago

Job Viewed

Tap Again To Close

Job Description

**Job Description**
**Job Summary**
Responsible for accurate and timely measurement of critical provider analytics including Network Adequacy and other critical metrics. Synchronizes data among multiple systems to ensure accurate reporting of the Provider Network across the enterprise. Validate data on provider databases and ensure adherence to business, system and regulatory requirements of Provider Data Management/Network Adequacy.
**Knowledge/Skills/Abilities**
+ Contributes as a key member of the Leadership Team and other committees addressing the strategic goals of the department and organization.
+ Develops and implements Provider Network and Contract strategies across all lines of business, identifying those specialties and geographic locations on which to concentrate resources for purposes of establishing a compliant network of participating Providers to serve the health care needs of the Plan's membership and to meet all state and federal requirements.
+ Actively mentors team members focused on analytics, reporting, and technical skill development based on personal experiences and skills in these areas of focus
+ Creates an environment where data and analytics professionals can develop their skills and grow their careers through taking on increased responsibility and adding value to the organization
+ Ensures strong operational processes are in place to deliver across all areas of responsibility
+ Provides oversight analyses of demographic data to support accurate Network Adequacy Reporting and Directory development.
+ Manage multiple resources and projects concurrently to ensure successful completion of analytic projects, including timeliness, quality and customer value.
+ Provides accurate Analytic work estimates and oversees delivery against Resources, ensures organization design and team are in place to deliver against plans
+ Serve as primary client contact on all phases of analytic projects from problem definition, assignment of Resources and through to resolution, appropriately managing Internal Customer expectations throughout the project.
+ Create compelling presentations for Internal Customers, Senior Leaders and Sales Teams, which tell the analytic story, demonstrating their value by providing actionable insights with recommendations
+ Capitalize on opportunities to cross-sell Analytic Tools and Solutions to existing Internal Customers, market the value of analytics services across the enterprise
+ Integrates work with other teams including New Markets team, Network Management, Product Teams, PDM and IT.
**Job Qualifications**
**REQUIRED EDUCATION:**
Bachelor's Degree in a related field (Business Administration, Finance, Mathematics, Statistics, Computer Science etc.) or equivalent experience
**REQUIRED EXPERIENCE:**
+ 7 - 10 years' experience in delivering analytic results working within complex data sets and analytics ideally in the Healthcare or Payer field
+ 3-5 years' experience managing/supervising employees or leadership capacity
+ Strong executive-level client facing skills and the ability to communicate complex analytical concepts with confidence to a non-technical executive audience
+ Ability and willingness to take a hands-on execution role where required to support client needs and team development
+ Highly organized with an ability to work under tight deadlines and shifting priorities
+ Excellent oral and written communication skills
+ Management and team mentoring
+ Highly professional and presentable with a strong business acumen
**PREFERRED EDUCATION:**
Master's Degree
**PREFERRED EXPERIENCE:**
+ Advanced Excel skills.
+ Power BI.
+ Provider Data Analytics.
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 - $172,484 / 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
 

Nearby Locations

Other Jobs Near Me

Industry

  1. request_quote Accounting
  2. work Administrative
  3. eco Agriculture Forestry
  4. smart_toy AI & Emerging Technologies
  5. school Apprenticeships & Trainee
  6. apartment Architecture
  7. palette Arts & Entertainment
  8. directions_car Automotive
  9. flight_takeoff Aviation
  10. account_balance Banking & Finance
  11. local_florist Beauty & Wellness
  12. restaurant Catering
  13. volunteer_activism Charity & Voluntary
  14. science Chemical Engineering
  15. child_friendly Childcare
  16. foundation Civil Engineering
  17. clean_hands Cleaning & Sanitation
  18. diversity_3 Community & Social Care
  19. construction Construction
  20. brush Creative & Digital
  21. currency_bitcoin Crypto & Blockchain
  22. support_agent Customer Service & Helpdesk
  23. medical_services Dental
  24. medical_services Driving & Transport
  25. medical_services E Commerce & Social Media
  26. school Education & Teaching
  27. electrical_services Electrical Engineering
  28. bolt Energy
  29. local_mall Fmcg
  30. gavel Government & Non Profit
  31. emoji_events Graduate
  32. health_and_safety Healthcare
  33. beach_access Hospitality & Tourism
  34. groups Human Resources
  35. precision_manufacturing Industrial Engineering
  36. security Information Security
  37. handyman Installation & Maintenance
  38. policy Insurance
  39. code IT & Software
  40. gavel Legal
  41. sports_soccer Leisure & Sports
  42. inventory_2 Logistics & Warehousing
  43. supervisor_account Management
  44. supervisor_account Management Consultancy
  45. supervisor_account Manufacturing & Production
  46. campaign Marketing
  47. build Mechanical Engineering
  48. perm_media Media & PR
  49. local_hospital Medical
  50. local_hospital Military & Public Safety
  51. local_hospital Mining
  52. medical_services Nursing
  53. local_gas_station Oil & Gas
  54. biotech Pharmaceutical
  55. checklist_rtl Project Management
  56. shopping_bag Purchasing
  57. home_work Real Estate
  58. person_search Recruitment Consultancy
  59. store Retail
  60. point_of_sale Sales
  61. science Scientific Research & Development
  62. wifi Telecoms
  63. psychology Therapy
  64. pets Veterinary
View All Healthcare Jobs View All Jobs in Omaha