Healthcare Services Operations Support Auditor

42102 Bowling Green, Kentucky Molina Healthcare

Posted 2 days ago

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Job Description

JOB DESCRIPTION
Job Summary
Provides support for non-clinical healthcare services auditing activities. Responsible for performing audits for non-clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
- Performs audits of non-clinical staff in utilization management, care management, member assessment, and/or other teams - monitoring for compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state and federal guidelines and requirements.
- Reports outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
- Ensures auditing approaches follow a Molina standard in approach and tool use.
- Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
- Demonstrates professionalism in all communications.
- Adheres to departmental standards, policies, protocols.
- Maintains detailed records of auditing results.
- Assists healthcare services with developing training materials or job aids as needed to address findings in audit results.
- Meets minimum production standards related to non-clinical auditing.
- May conduct staff trainings as needed.
- Communicates with quality, and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.
Required Qualifications
- At least 2 years health care experience, preferably in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
- Strong analytical and problem-solving skills.
- Ability to work in a cross-functional, professional environment.
- Ability to work on a team and independently.
- Excellent verbal and written communication skills.
- Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
- Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) non-clinical review/auditing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $24 - $56.17 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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VP, Healthcare Services (Work Location: Kentucky)

Kentucky, Kentucky Molina Healthcare

Posted 2 days ago

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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**
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.
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VP, Healthcare Services (Work Location: Kentucky)

42102 Bowling Green, Kentucky Molina Healthcare

Posted 2 days ago

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**
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.
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Program Manager, Healthcare Services - Clinical Systems

42102 Bowling Green, Kentucky Molina Healthcare

Posted 2 days ago

Job Viewed

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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.
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Auto Care Center Technician

42320 Beaver Dam, Kentucky Walmart

Posted 2 days ago

Job Viewed

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Job Description

Hourly Wage: **$17 - $0 per/hour**
*The actual hourly rate will equal or exceed the required minimum wage applicable to the job location.
Additional compensation includes annual or quarterly performance incentives.
Additional compensation in the form of premiums may be paid in amounts ranging from 0.35 per hour to 3.00 per hour in specific circumstances. Premiums may be based on schedule, facility, season, or specific work performed. Multiple premiums may apply if applicable criteria are met.
Employment Type: **Part-Time**
Available shifts: **Mid-Shift, Closing**
Location
**Walmart Supercenter #333**
1701 N MAIN ST, BEAVER DAM, KY, 42320, US
Job Overview
These Auto Care Center roles focus on the needs of our customers who entrust us with the care of their vehicles as they shop for merchandise and services offered at Walmart. The Auto Care Center is a rewarding place to work with opportunities for advanced associate training, business development, and application of technology.
Benefits & perks
At Walmart, we offer competitive pay as well as performance-based incentive awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more.
You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable. For information about PTO, see Smart Guide page ( Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms. For information about benefits and eligibility, see One.Walmart.com.
Walmart is committed to maintaining a drug-free workplace and has a no tolerance policy regarding the use of illegal drugs and alcohol on the job. This policy applies to all employees and aims to create a safe and productive work environment.
Walmart, Inc. is an Equal Opportunity Employer- By Choice. We believe we are best equipped to help our associates, customers, and the communities we serve live better when we really know them. That means understanding, respecting, and valuing diversity- unique styles, experiences, identities, abilities, ideas and opinions- while being inclusive of all people.
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