Molina Healthcare

  • Phoenix, AZ, USA
Nov 26, 2021
Molina Healthcare Remote * (Long Beach, CA, USA)
Job Description The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant all applicable State, CMS, and NCQA requirements, as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the team. This position is currently remote/work-from-home, but will eventually require onsite visits at the offices of our delegates (in San Diego, San Bernardino, Riverside, Orange, Los Angeles, and Sacramento), as well as some in-office days in our Long Beach HQ. Job Summary Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and State Medicaid requirements including delegation standards and requirements contained in the delegation agreement. Knowledge/Skills/Abilities The Delegation Oversight Nurse is responsible for ensuring that...
Nov 20, 2021
Molina Healthcare Remote * (Midvale, UT, USA)
This position is currently remote due to COVID, but may (or may not) go back into the Midvale, Utah office in the fall. This position is Monday through Friday with scheduled hours between 8:00 am to 6:30 pm (ex. 8:30-5, 8-4:30, 9:30-6, etc.). Molina Pharmacy Services/Management staff work to ensure that Molina members have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state laws. Jobs in this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance...