- Molina Healthcare (Dallas, TX)
- …of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops ... infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and… more
- Molina Healthcare (Dallas, TX)
- …by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the standards and controls that ... for CMS audits and data-validation reviews * Ability to quantify financial, regulatory , and member-experience risk from complaint trends and to drive prioritized… more
- Molina Healthcare (Dallas, TX)
- …Medical License without restrictions (free of sanctions from Medicaid or Medicare ) **PREFERRED EDUCATION:** Master's in Business Administration , Public Health, ... **Job Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of… more
- Molina Healthcare (Dallas, TX)
- …medical director , and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality ... without restrictions to practice and free of sanctions from Medicaid or Medicare . **PREFERRED EDUCATION:** Master's in Business Administration , Public Health,… more
- Molina Healthcare (Dallas, TX)
- **Job Description** **Job Summary** The National Program Director - Value-Based Care is a strategic leadership role responsible for the development, implementation, ... evolution of value-based care (VBC) programs across all lines of business-Medicaid, Medicare , and Marketplace. This role is critical in driving clinical and… more
- Molina Healthcare (Dallas, TX)
- …and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct management and ... to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. * Manages the contracting relationships with area agencies and… more
- Molina Healthcare (Dallas, TX)
- …between Molina Healthcare and contracted provider network. In partnership with Director , manages and coordinates the Provider Services activities for the state ... outreach and resolving provider inquiries. * In conjunction with the Director , Provider Network Management & Operations, develops health plan-specific provider… more
- Molina Healthcare (Dallas, TX)
- …Degree in preferred field: Nursing, Social Work, Clinical Quality, Public Health, or Healthcare Administration + 1 year of experience in Medicare and in Medicaid ... quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid) Executes health plan's member and community quality… more