Humana Jobs

**Become a part of our caring community and help us put health first** Humana's Clinical Analytics Team is seeking a Strategy Advancement Advisor who is has strategy consulting experience to join working remote anywhere in the US. The Clinical Analytics Team delivers enterprise value by leveraging advanced analytics and strategic insights to drive informed decision-making and execute clinical priorities. As the Strategy Advancement Advisor, you will lead initiatives to analyze complex business problems and issues using data from internal and external sources. You will bring expertise in support of multi-functional efforts to identify, interpret, and produce recommendations and plans based on company and external data analysis. **Primary Role Functions** **Strategic planning support:** + Collaborate with senior team members to determine and prioritize business strategies + Coordinate with leadership to complete vision / mission development and articulate strategic priorities + Maintain the team's vision, annual and long-term plans, OKRs, and other far-reaching strategy documents + Coordinate dependencies and other inter-related efforts across teams (especially when priorities conflict) and facilitate work by ensuring teams have the resources they need **Portfolio management:** + Ensure strategic alignment across the portfolio + Create structure to properly prioritize initiatives/projects that align with strategic objectives. + Develop and lead the prioritization process, identify tradeoffs and make recommendations to leadership on selection to ensure the business is working on the right things **Manage operating cadence and business rhythm:** + Establish, document, and mature repeatable processes for critical business functions that occur on a regular cadence like team meetings, budget planning, strategic planning, headcount planning, along with the overall planning and execution tempo of the organization + Partner with human resources, finance, procurement, and legal among other teams to ensure the organization's smooth operation **Internal communications** : + Compile regular updates on business activities to generate cross-team awareness + Partner to plan leadership team meetings, all-hands meetings, and other cross-team events + Assist in shaping organizational culture, values, and expectations + Partner with culture, associate experience, communications, and other teams to leverage their expertise as appropriate **Executive communications** + Maximize internal voice with key stakeholders (Medicare & Medicaid leadership, Management Team, Board of Directors, etc.) which includes preparation and after-action reviews with significant meeting forums + Set agendas, establish deadlines, collaborate with presenters to develop materials, ensure materials are high quality, own end-to-end content review prior to the meeting, and capture and making any necessary edits **Monitoring and evaluating organizational progress:** + Define, align, and track success metrics + Identify gaps and make recommendations for improvement + Establish, operate, and improve the systems that capture, track, and regularly report on work in flight, especially strategic or other cross-functional initiatives, to ensure situational awareness at all levels + Present recommendations to mitigate risks and resolve conflicts **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree + 4 years or more healthcare payer, analytics or related field + Strategy consulting experience + 2 years or more working with executive leaders + Excellent communication and interpersonal skills + Proven track record of managing complex projects and driving organizational success + Demonstrated ability to lead, manage, and coordinate the execution of cross-cutting, strategic workforce + Working understanding of AI and analytics or proven experience of new topic ramp up to become a thought leader in the topic **Preferred Qualifications** + Master's degree **Additional Information** **This role is a 100% remote role anywhere in the US and will primarily operate on Eastern Standard Time business hours.** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including: + Health benefits effective day 1 + Paid time off, holidays, volunteer time and jury duty pay + Recognition pay + 401(k) retirement savings plan with employer match + Tuition assistance + Scholarships for eligible dependents + Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities **Our Hiring Process** As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you. If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $115,200 - $158,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 03-28-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. Supports effective implementation of performance improvement initiatives for capitated providers. Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Assists in the development and implementation of physician education with respect to clinical issues and policies. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. Develops alliances with the provider community through the development and implementation of the medical management programs. As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. Represents the business unit at appropriate state committees and other ad hoc committees. May be required to work weekends and holidays in support of business operations, as needed. Education/Experience: Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred. License/Certifications: Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association's Department of Certifying Board Services. Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs. Pay Range: $231,900.00 - $440,500.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Provides consultative support and medical cost-based analysis of markets and network initiatives. The Medical Economics Consultant manages conflicting priorities and multiple projects concurrently. Responsible for extracting, analyzing, and synthesizing data from various sources to identify risks and opportunities as well as packaging and delivering the results to senior leadership. Responsible for consulting with network and clinical management on opportunities to improve our company's discount position and strategic cost and utilization initiatives. **Knowledge/Skills/Abilities** + Analyze and research utilization and unit cost medical cost drivers + Turn data into usable information by tell the story through data visualization working with clinical, provider network and other personnel to bring supplemental context and insight to data analyses + Support the development of scoreable action items by identifying outlier cost issues + Perform drill-down analysis to identify medical cost trend drivers; advise network of contracting opportunities to mitigate future trends + Own, track and document all aspects of related work from beginning to end of a project + Extract and compile information from various systems to support executive decision-making + Ability to mine and manage information from large data sources + Working with Excel, MS-Access and Web-based query tools (data warehouse) **Job Qualifications** **REQUIRED EDUCATION:** Bachelor's Degree in Finance, Mathematics, Statistics, or Economics **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** 5 - 7 years in healthcare/managed care industry with knowledge of provider contracting, provider reimbursement, patient management, product, benefits design, or related experience. **PREFERRED EDUCATION:** Master's Degree in Business Administration, Finance, Mathematics, Statistics, or Economics **PREFERRED EXPERIENCE:** Experience working with medical and pharmacy claims, authorization data, benefits design, medical management as well as knowledge of business functions and impact on financials (underwriting, sales, product development, network management.) 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: $92,474 - $188,164 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Molina's Quality Improvement Lead Overreader conducts oversight and audits of the data collected and abstracted from medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The Lead Overreader meets chart overread productivity standards, minimum over read standards, and 2nd overread standards to ensure accuracy of their audit skills, as well as oversee the overread team to ensure they are on track to meet standards as well. Lead Overreader mentors and trains new team members. Leads special HEDIS/Quality projects. **Job Duties** + Performs the lead role of the HEDIS medical record review overreader/auditor which includes ongoing review of records reviewed and data entered by the abstraction team during the annual HEDIS medical record review as well as all other HEDIS/HEDIS like project, the Lead Overreader will act as the subject matter expert for the team. + Provides feedback to providers on visit notes or feedback from the HEDIS audit. Makes recommendations based off of the audit and chart review. + Assists Manager and Supervisor(s) in leading the training and mentoring of new staff and takes the lead role in these activities, utilizing the standardized training materials and job aids. + Lead the team during HEDIS audits as well as ad hoc projects. + Leads the scheduled meetings with the Abstraction team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. + Works with the Manager to monitor accuracy of abstracted records as required by specifications. + Assists the quality improvement staff with physician and member interventions and incentive efforts as needed through review of medical records documentation. + Assists as needed in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation. + Provides data collection, presentations and report development support for quality improvement studies and performance improvement projects. **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:** - 5 years experience in healthcare Quality/HEDIS specific to overreading **PR** **E** **FE** **R** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:** + At least 3 years of experience in the overread role. + 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 **PHY** **S** **I** **C** **AL DEM** **A** **N** **D** **S** **:** 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: $30.37 - $61.79 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**Become a part of our caring community and help us put health first** The Value-Based Programs Specialty Care Lead supports the creation of complex value-based programs. The Value-Based Programs Lead provides strategic advice and guidance to functional team(s) related to value-based vendor and specialty deals. In supporting Humana's Value-Based Strategies organization, the Value-Based (VB) Programs Lead will be accountable for the development of new innovative VB provider payment models designed to promote improved quality, outcomes, and cost of care. Primary responsibilities of this role will be the evaluation of VB Payment Model efficacy and scalability as we seek to broaden our core VB Program portfolio. The ultimate goal is to lay the foundation with providers for additional partnerships that help create the most integrated and value based relationships in the industry. + Develops, designs, and implements new payment arrangements that improve quality and the member experience + Works with senior executives and various program owners to develop and drive value based contracts for vendor and specialty programs + Becomes an expert in the data available from disparate sources and use this information to conduct business analyses and recommend implementation and execution plans + Conducts complex financial and other data analysis and makes recommendations (cost-benefit, market recommendations, strategy pro-forma, and impact analysis) that significantly impact the market operations + Assesses emerging trends, develops formulas to measure and manage initiative success + Designs complex mathematical models to help drive contractual decisions + Manages the development and review/measurement of key business priorities + This is an individual contributor role + This role reports to the Associate Vice President of Value Based Strategies In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include: + Medical Benefits + Dental Benefits + Vision Benefits + Health Savings Accounts + Flex Spending Accounts + Life Insurance + 401(k) + PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time + And more **Use your skills to make an impact** **Required Qualifications:** + 5+ years of experience in a corporate strategy role or financial leadership role + 3+ years of healthcare contracting experience + Experience in managing the strategic planning cycle for a large organization with cross-functional engagement and prioritization + Excellent written and verbal communication skills + Problem-solving leadership skills with limited oversight + Flexible, dynamic personality who works well in a team environment **Preferred Qualifications:** + BA/BS degree in Accounting, Finance, or Mathematics + MBA or graduate degree in a management field + Experience executing complex strategic and operational initiatives + Clinical experience or certification + Knowledge of Humana's internal policies, procedures and systems **Additional Information** Work at Home/Remote Requirements **Work-At-Home Requirements** + To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate. + Wireless, Wired Cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.) + Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **Our Hiring Process** As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging, and/or Video Interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone or computer. You should anticipate this interview to take approximately 10-15 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker. \#LI-LM1 **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $104,000 - $143,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 03-26-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. **KNOWLEDGE/SKILLS/ABILITIES** + Analyze and interpret data to determine appropriate configuration changes. + Accurately interprets specific state and/or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters. + Handles coding, updating and maintaining benefit plans, provider contracts, fee schedules and various system tables through the user interface. + Apply previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system(s) as necessary. + Works with fluctuating volumes of work and is able to prioritize work to meet deadlines and needs of user community. + Must have strong experience with Benefits and contracts configuration in QNXT + Must have claims processing experience + Knowledge is SQL + Experience is Excel is required + Experience in Networx is required **JOB QUALIFICATIONS** **Required Education** Associate degree or equivalent combination of education and experience **Required Experience** 2-5 years **Preferred Education** Bachelor's Degree or equivalent combination of education and experience **Preferred Experience** 5-7 years 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 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**_***Residents in CENTRAL Time Zone preferred. Candidates who do not live in Central Time zone must work CENTRAL DAYTIME BUSINESS HOURS._** **_Work Schedule: 4 days a week - 10hrs a day. Schedule will be alternating every 4 weeks Monday-Thursday and Wed - Saturday._** **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. + Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage). + Reviews medically appropriate clinical guidelines and other appropriate criteria with Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and reports quality of care issues. + Prepares and presents cases in conjunction with the Chief Medical Officer for Administrative Law Judge pre-hearings, State Insurance Commission, and Meet and Confers. + Represents Molina and presents cases effectively to Judicial Fair Hearing Officer during Fair Hearings as may be required. + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. + Provides training, leadership and mentoring for less experienced appeal LVN, RN and administrative staff. **JOB QUALIFICATIONS** **Required Education** Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. **Required Experience** + 3-5 years clinical nursing experience, with 1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as needed or equivalent experience (such as specialties in: surgical, Ob/Gyn, home health, pharmacy, etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. + Experience demonstrating knowledge of CMS Guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable State regulatory requirements, including the ability to easily access and interpret these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing (RN) license in good standing. Compact / multi state licensure **Preferred Education** Bachelor's Degree in Nursing **Preferred Experience** 5+ years Clinical Nursing experience, including hospital acute care/medical experience. **Preferred License, Certification, Association** Any one or more of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified Professional in Healthcare Quality + other healthcare 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: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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** + Supervises operations support team members within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff. + Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns. + Researches and analyzes the workflow of the department and offers suggestions for improvement and/or changes to management; assists with the implementation of changes. + Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance. + Provides regular verbal and written feedback to staff regarding work well done and opportunities for improvement. + Assists in the development and implementation of internal desktop processes and procedures. + Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers. **JOB QUALIFICATIONS** **Required Education** High School Diploma or equivalent GED **Required Experience** + 2+ years' experience in an administrative support role in healthcare, Medical Assistant + Strong communication skills + Strong analytic and problem-solving abilities **Preferred Education** Associate's or bachelor's degree **Preferred Experience** + 1+ years of supervisory experience + 3+ years' experience in an administrative support role in healthcare, Medical Assistant 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: $77,969 - $106,214 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for the management of the benefits, operations, communication, reporting, and data exchange of the Medicare/MMP product in support of strategic and corporate business objectives. Manage for all Medicare lines of business the annual Medicare and Medicare-Medicaid Plan Applications and Plan Benefit Package design, as well as provide centralized year-round support of Medicare Growth Marketing, for the development and core editing of materials as required by Mandated Materials team, to include the Annual Notice of Change, Medicare Summary of Benefits, evidence of Coverage and Mid-Year Supplemental Benefit Notices for print and online distribution via the Data Automation Tools, ensuring compliance with CMS and State guidelines. Support Medicare and MMP line of business for upcoming contract year business readiness. This position also needs to assist in the development, implementation, and maintenance of annual timelines/work plans to ensure timely and successful project completion including adhoc projects and submissions as assigned by the Manager of Mandated Materials or designee. **KNOWLEDGE/SKILLS/ABILITIES** + Experience in developing materials in data automation tools, SQL queries (optional) + Initiate projects by documenting the project scope including goals, objectives, timelines, milestones, deliverables and obtaining approval of the project owner. + Plan projects by creating process improvement workflows, project presentations, work plans, establishing due dates, and assigning task responsibilities. + Guides project efforts by leading work teams and utilizing effective project management tools to achieve desired project results. + Monitor and control projects by measuring progress according to plan and making course corrections as needed to keep the project on track. + Provide interim reports and keeping the project sponsor and stakeholders informed of progress and risks. + Serves in an internal consultant capacity and possesses ability to rapidly learn, assess, and implement projects. + Develop and distribute internal communications. + Spearhead submission of Medicare and MMP materials (as assigned), annual Medicare Bid and PBP, ANOC/EOC, and Summary of Benefits working closely with a variety of internal and external partners. Responsible for staying up to date with the latest communications and guidance provided by CMS as it relates to applicable projects. + Coordinate cross-departmental informational updates - focusing on teamwork, information flow and support data to promote cross-training and unified team direction. + Collaborates with implementation team for Annual implementation and roll out of business expansion for Medicare/MMP lines of business. + Ensures materials developed are 508 compliant for web posting and receive Certificate of Accuracy (COA) for translations. **JOB QUALIFICATIONS** **Required Education** + Bachelor's degree or equivalent years of education and experience **Required Experience** + 1-2 years of experience in Information Technology, database Content Management Systems environments. + 5+ years in healthcare process design and development, business analysis, compliance, project management or related experience. + 2 years' experience in Medicare and/or healthcare + 1+ year experience in project management. **Preferred Experience** + 1-2 years in content management systems + 3-5 years in project coordination/management, business analysis, compliance. 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 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**Molina Healthcare** is hiring for a Project Manager, Change Management Liaison, Medicaid Claims. This role acts as the Business Owner and is responsible for ensuring the health plan is ready for any change focusing on Provider and Provider Claims/Claims payment. Highly qualified candidates should be very strong in Provider Claims and Provider Relations. Candidates should also have a high proficiency with Excel and SQL. This role will plan and direct schedules as well as project budgets. Monitors projects from inception through business readiness and delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. This positions' primary focus is project/process/program management along with continuous improvements related to improving the provider experience. **KNOWLEDGE/SKILLS/ABILITIES** + Manages all aspects of assigned projects throughout the project lifecycle including project scope, schedule, resources, quality, costs, and change. + Develops and maintains detailed project plan to include milestones, tasks, and target/actual dates of completion. + Revises project plans as appropriate to meet changing needs and requirements. + Prepares and submits project status reports to management. + Schedules and conducts project meetings to include logistics, agendas, and meeting minutes. + Ensure successful hand off from project status to business as usual status. **JOB QUALIFICATIONS** **Required Education** : Associate degree or equivalent combination of education and experience. **Preferred Education** : Bachelor's Degree or equivalent combination of education and experience **Required Experience** : 3-5 years' experience. **Preferred Experience** : 5-7 years' experience in any of the or combination of the following- + **Medicaid Claims Expertise** - Strong experience in Medicaid claims configuration, adjudication, and payment processes. + **Claims Troubleshooting & Issue Resolution** - Deep understanding of the end-to-end claims lifecycle, including the interactions between provider contracts, provider data, contract configuration IDs, clearinghouse processes, EDI systems (such as Edifecs), claims adjudication, claims payment, and encounter submissions. + **Product & Contract Configuration Knowledge** - Experience managing dependencies related to product and contract configuration within a Medicaid managed care environment. + **Independent Problem-Solving & Process Improvement** - Proven ability to troubleshoot issues independently with a strong bias for identifying root causes and implementing process improvements. + **Claims Configuration & Payment Leadership** - 5-7 years of hands-on experience in claims configuration, ensuring accurate processing and compliance with Medicaid regulations. + **Medicaid Managed Care Project Management** - Experience leading or supporting operational projects within a Medicaid managed care setting. + **Process Management & Optimization** - Strong ability to assess, refine, and document business processes to drive efficiency and accuracy **.** + **Microsoft SharePoint & Teams Proficiency** - Experience leveraging Microsoft SharePoint and Teams for collaboration, document management, and workflow automation. **Preferred License, Certification, Association** : PMP or Six Sigma Green Belt 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. Key Words: Project Management, Business Owner, Healthcare, Data, Provider, Provider Liaison, Claims, Provider Claims, Stakeholder Engagement, Regulatory Compliance, Risk Management, Process Improvement, Data Analysis, Quality Assurance, Change Management, Agile Methodology, Strategic Planning, Resource Allocation, Performance Metrics, Vendor Management, Workflow Optimization, Healthcare Policies, Regulations, Clinical Operations, Leadership, Time Management, Communication Skills, Process Mapping, Training and Development, Healthcare Analytics, Regulatory Affairs, Medicaid Claims Expertise, Product Owner, Product knowledge, Claims Configuration & Payment Leadership, Process Management & Optimization Pay Range: $77,969 - $135,480 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**Become a part of our caring community and help us put health first** The Insurance Product Compliance Professional 2 researches, analyzes, assesses risk and consults on rules, regulations and sub-regulatory guidance that apply to Medicare Insurance Products, specifically Dual Eligibles. The Insurance Product Compliance Professional 2 work assignments are varied and will provide assistance and support to the overall team. The Insurance Product Compliance Professional 2 partners with internal stakeholders and assist with upcoming deliverables; product-specific documents, contracts, licenses, member communications or marketing materials, all while safeguarding Humana's brand. Supports maintenance of compliant insurance products in collaboration with responsible business owners. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Experience with Medicare Advantage and/or Medicaid + Comprehensive knowledge of Microsoft Office applications: Word, Excel, PowerPoint, Adobe and Visio + Ability to summarize complex information and tailor communication based on audience + Ability to work independently while maintaining focus and managing deliverables to meet critical internal and external deadlines + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + Ability to affect change in a highly matrixed organization, leveraging data and facts to influence decision-makers **Preferred Qualifications** + Understanding of State and Federal Regulations + Experience with Medicare Advantage plan and benefit offerings + Experience specific to Dual Eligible members and healthcare plans for MA DSNP product offerings + Knowledge of Humana's internal policies, procedures and systems + Prior project management or product management experience **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $59,300 - $80,900 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 04-03-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

**Become a part of our caring community and help us put health first** The Associate Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position. The Associate Actuary, Analytics/Forecasting work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Associate Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of data. Collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts root cause analysis, and develops cost effective resolutions for data anomalies. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree + Associate of Society of Actuaries (ASA) designation + MAAA + Strong communication skills + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Proficient in SAS + Comfort in Communicating technical concepts to non-actuarial audiences + Highly Collaborative + Knowledge of Value Based Contracts is a plus + Knowledge of Medicare members, claims, and revenue **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $106,900 - $147,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 05-29-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

A career within Forsyth Health's Data & Analytics team will provide you with the opportunity to help Pharma/Life Science organizations uncover patient and market insights. At Forsyth Health, we focus on a collection of data management, business intelligence and advanced analytics capabilities to support various functions within these organizations to meet their business needs around market access and patient support programs. **How you'll make a difference:** The Sr. Advisor, Real World Data position is a key role to the enterprise and will be supporting a highly complex and growing area within the health care data and analytics services space. As a strong individual contributor, the role will lead client engagements to define, develop and communicate insights critical to Commercial, Market Access, HEOR and Evidence Generation functions at Pharma/Life Science. Responsibilities include leading Outcomes Research studies, Advanced Analytics, ML model development and general analytic support for all stakeholders. This role will work closely with the internal Sales and Technology teams. This person will need to be able to understand the needs within the Commercial Pharma Analytics space and translate those into actionable insights. **Role Summary:** The Sr. Advisor, Real World Data position is an opportunity for an analytics professional to provide leadership on complex analytics projects and initiatives. This role will work with an innovative team on setting and executing the vision for how advanced embedded analytics can lead Forsyth Health to achieving our growth goals. This role will work collaboratively with internal and external stakeholders to provide partnership in analytics, developing RWD analytics solutions to inform Commercial & Market Access Analytics, leveraging advanced analytic and technologic capabilities and embedding analytics driven processes. **Job Responsibilities** The job responsibilities include, but are not limited to the following: + Efficiently query multiple data types (medical and pharmacy claims, EMR, lab, chargemaster) using SQL to identify populations of interest in HVM data and assess using univariate analysis and data investigations + Empower clients to generate RWE utilizing best-in-class observational research by conducting pre-sale feasibility analyses of varying breadth and depth + Provide clients with RWD training, analytic guidance, and use case support in the post-sale phase + Develop and communicate technical, clinical, operational, and business specifications to internal and external teams + Work cross-functionally to support operational processes to deliver data licensing projects on time and with accuracy + Develop new reports and analytic solutions with innovative ways to present data internally and externally in order to support Forsyth Health's Sales & Business stakeholders. This requires combining business knowledge and data acumen along with technical (SAS, SQL) skills to efficiently complete these ad-hoc requests. + Consultation with Data & Analytics matrix partners to develop best practices and help understand complex issues and requests. Cross-Functional collaboration as needed to create alignment with stakeholders. + Project management and prioritization - Advisor role will support multiple projects and will need to be able to work with Forysth Health Sales' and Analytics team to manage multiple initiatives at the same time and negotiate timelines/priority with stakeholders. + Explore and visualize the data using Business Intelligence tools such as including Tableau, PowerBI, Thoughtspot and/or Looker. (Largely Tool agnostic environment) + Extraction and analysis of large healthcare claims data using state of the art big-data infrastructure leveraging cloud and on premise tools i.e. SAS, SQL based programming, Analytic platform (Python), R, Teradata, Hadoop, etc. **Qualifications:** + BS/MS/PhD in Econometrics, Actuarial Science, Business Analytics, Data Science, Health Outcomes, Epidemiology, Statistics, or in any technical field that provides a solid basis for analytics highly desired. + At least 3 years experience using SQL, programming against large relational databases leveraging interoperably-linked, patient-level data at scale + Healthcare data expert across various data types (e.g. open/closed claims, inpatient/ambulatory EMR, commercial labs, social determinants, etc.) and codified healthcare data standards (e.g. ICD, CPT, HCPCS, CVX, LOINC, NUCC, NPPES, etc.) + Experience evaluating fit-for-purpose data and implementing research protocols + Experienced applying RWD to specific healthcare and life sciences-related research questions and use cases, such as RWE/epidemiology, HEOR, R&D, commercial, public health + A demonstrated ability to understand and effectively communicate (both verbally and written) analytic and clinical data to a varied audience. + Deep healthcare data (e.g., PBM experience, Provider Networks, Billing, Medical and Pharmacy claims), statistical analysis experience, and an understanding of all the associated clinical, utilization and financial levers. + Experience with statistical software/programming languages such as SQL programming, SAS, R, Python and other tools preferred (Python knowledge not requisite but preferred). + Experience with data visualization tools such as Alteryx, Tableau, Thoughtspot or PowerBI. + A data-driven personality w/ Intellectual curiosity and internal motivation. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. **About The Cigna Group** Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. _Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._ _If you require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._ _The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._ _Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._

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 metrics regarding patient outcomes, medications safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** + Performs initial receipt and review of non-formulary or prior authorization requests against plan approved criteria. Requests additional information from providers as needed to properly evaluate the request. + Accurately enters on-line approvals or denials of requests. Authorized to make and carry out simple prior authorization requests within established policies and procedures. + Participates in the development /administration of programs designed to enhance the utilization of targeted drugs and the identification of cost saving pharmacy practices. + Identifies and reports departmental operational issues and resource needs to appropriate management. + Assists Molina Member Services, pharmacies, and health plan providers in resolving member prescription claim, prior authorization, or pharmacy services access issues. + Articulates Pharmacy Management policies and procedures to pharmacy/health plan providers, other Molina staff and others as needed. **JOB QUALIFICATIONS** **Required Education** High School Diploma or GED equivalent **Required Experience** 2 years' experience as a Pharmacy Technician **Required License, Certification, Association** Active and unrestricted Pharmacy Technician Certification **Preferred Education** Associate degree **Preferred Experience** 3+ years 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: $18.29 - $26.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

This position will be responsible for supporting the execution of merger and acquisition transactions and will actively contribute in advancing Molina Healthcare's overall growth strategy. The role entails working closely with the senior members of the Corporate Development team and will actively interact with the business leaders and senior management team at Molina. The ideal candidate will have at least two years of experience as an analyst at an investment bank or similar firm. **Knowledge/Skills/Abilities** - Develop financial models and perform analyses to assess potential acquisition, joint venture and other business development opportunities (i.e., discounted cash flow, internal rate of return and accretion/dilution) - Prepare ad-hoc analyses and presentations to help facilitate various discussions - Research and analyze industry trends, competitive landscape and potential target companies - Coordinate deal activities among internal cross-functional teams and external parties - Coordinate due diligence and closing-related activities - Actively participate in reviewing and negotiating transaction agreements - Prepare board and senior management presentations **Job Qualifications** **REQUIRED EDUCATION:** Bachelor's degree in Accounting or Finance or related fields **REQUIRED EXPERIENCE:** + Minimum 5 years' experience in financial modeling and analysis + Ability to synthesize complex ideas and translate into actionable information + Strong analytical and modeling skills + Excellent verbal and written communication skills + Highly collaborative and team-oriented with a positive, can-do attitude + Ability to multi-task, set priorities and adhere to deadlines in a high-paced organization **PREFERRED EXPERIENCE:** + Prior analyst experience in investment banking strongly preferred + Healthcare industry experience preferred **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. \#PJCorp \#LI-AC1 Pay Range: $80,412 - $156,803 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Manages a team of professional Configuration Analysts. Responsible for operational activities for the assigned team, including accurate and timely implementation and maintenance of critical information on claims databases. Validate data to be housed on databases and ensure adherence to business and system requirements of Health Plans as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. **KNOWLEDGE/SKILLS/ABILITIES** + Meet and exceed all performance metrics and department goals. + Understand conflicts with teams and provide solutions. + Ensure all team members comply with company and legal requirements. + Ensure tasks are completed with accuracy and efficiency. Sets the right priorities and systematically identifies the root cause of challenges. + Works with the business and project development teams to assess and recommend the appropriate configuration design, solutions, and methodology for new and existing business. + Develops standard operating procedures and guidelines for the Configuration team. + Provides status reports and project updates to management and stakeholders. + Ensure staff have all the resources they need to perform at a high level. + Conduct performance reviews, training, and corrective action as appropriate. + Understanding of complex payment methodologies + Understanding of complex configuration solutions + Advanced knowledge of health care benefits. + Advanced knowledge of healthcare claims and claim processing from receipt through encounter submission. + Ability to adopt and utilize work tracking software + Strong business writing skills; proficient user of Microsoft Products including Word, Excel, Outlooks, Teams, SharePoint, PowerPoint, and Visio + Advanced knowledge of Excel preferred + SQL knowledge preferred + Coding certification preferred + Knowledge of configuration in QNXT strongly preferred **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree or equivalent combination of education and experience **Required Experience** 5-7 years **Preferred Education** Graduate Degree or equivalent combination of education and experience **Preferred Experience** 7-9 years 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 - $188,164 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**_Training for this position is approximately 6 weeks. No PTO/time off requests will be approved during training. The 6 weeks of training are essential to your onboarding and ability to learn all aspects of the role, and missing time cannot be accommodated._** **POSITION SUMMARY** The Staff Pharmacist interprets physicians' prescriptions, contacts doctors or other prescribers and/or patients to verify information on prescriptions and expedite processing of order. The Staff Pharmacist will track order status and outstanding issues as well as consult with patients regarding the use of medications and potential drug interactions. This individual may take calls from customers regarding lost orders or dispensing errors, maintain daily production, quality and service levels, vary work priorities and activities to accommodate business needs. The Staff Pharmacist may also train less experienced pharmacists. In order to meet licensure requirements for this position you must be licensed in and live in the state of OH, AZ or FL. Please Note: Work Schedules are still being determined so flexibility is required. Schedules will likely be 2nd shift and include evenings and weekends **ESSENTIAL FUNCTIONS** + Consult with patients regarding prescriptions + Interpret physicians' or prescribers' prescriptions. + Contact doctors and/or patients to verify information on prescriptions such as drug strength, prescription sig., and drug name in order to expedite processing of orders. + Verify and confirm validity of controlled substances. + Verify prescription information entered in the system by data entry or order entry. + Contact physicians for new and/or transfer authorization. + Work with physicians to convert prescriptions to generic or preferred drugs whenever possible. + Back up other pharmacists as needed, perform additional duties as assigned by management, or train less experienced pharmacists. **QUALIFICATIONS** + Registered pharmacist in the state of practice + Highly-evolved clinical pharmacy skills and/or clinical knowledge of a specific disease state + Superior written and verbal communication skills + Proficient in use of computer applications + Demonstrated commitment to ongoing self-study to enhance specialty knowledge + Demonstrated ability to work independently, solve problems and make informed decisions in a timely fashion + Excellent customer service and interpersonal skills + Demonstrated ability to effectively and professionally represent Express Scripts to patients, clinicians, clients and the public + Ability to successfully complete Express Scripts' required specialist training program + Spanish language fluency is a plus If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. **About Evernorth Health Services** Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. _Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._ _If you require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._ _The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._ _Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._

+ Responsible for executing, monitoring, and training inventory best practices and standard operating procedures for the entire store, including both front end and pharmacy. Supports pharmacy inventory management activities, including receiving, counting, ordering, and facilitating returns. Champions On-Shelf Availability and is responsible for receiving, counting, pricing, returns, and all in-store inventory processes. Validates and ensures accuracy of planograms. + Responsible for reviewing and coordinating the proper use of reports and system applications, which have an impact on the accuracy of front end and pharmacy on-hand balances and pricing. + Responsible for executing and maintaining front end and pharmacy asset protection techniques, and filing claims for warehouse and vendor overages (merchandise received, but not billed), shortages (merchandise billed, but not received), order errors or damaged goods including prescription drugs. + In designated stores, as required, opens and closes the store in the absence of store management, including all required systems start-ups, required cash handling and cashier responsibilities, and ensuring the floor and stock room are ready for the business day. **Customer Experience** + Engages customers by greeting them and offering assistance with products and services. In designated stores, when serving as the leader on duty, resolves customer issues and answers questions to ensure a positive customer experience. + Models and shares customer service best practices with all team members to deliver a distinctive and delightful customer experience, including interpersonal habits (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., offering help proactively, identifying needs, servicing until satisfied, etc.). **Operations** + Executes and coaches team members on warehouse and vendor inventory management processes including but not limited to creating, reviewing, and receiving orders. + Scans in all deliveries while the vendor is still in the store, including common carrier deliveries. Focuses on One Box receiving. Takes the appropriate action marking delivery as received if the product was physically delivered, contacting vendor for past undelivered scheduled receipts, and opening tickets as needed to correct inaccurate orders. + Under the supervision of the pharmacist-in-charge, verifies all pharmacy shipments are posted for products physically received at the store. Completes or verifies postings of all pharmacy warehouse orders, ABC prescription and OTC orders daily, secondary vendor orders, flu and dropship orders performing any necessary tote audits, and accurately reporting any shortages or damaged product. + Completes On-Shelf Availability (OSA) end-to-end process including warehouse and direct store delivery (DSD) for planogrammed departments, executing disposals, call-ins, and vendor returns before expiration, completes scan outs/ scan outs returns on all subscribed departments including vendor/ DSD departments and pharmacy scan outs. + Under the supervision of the pharmacist-in-charge,completes pharmacy inventory activities including but not limited to pharmacy recalls following Pharmacy Hazardous Waste Policy, vendor returns, non-controlled, and damaged salvage returns. Facilitates excess inventory returns or interstore pharmacy transfers where applicable for non-returnable ABC overstock. Verifies posting of all pharmacy/ prescription claims. + Completes execution of all pricing activities including price changes, markdowns, and markdowns deletes. Responsible for basic department pricing, including daily price changes, accurate pricing with correct signage, and reliable and timely completion of any additional regulatory pricing tasks. + Responsible for supporting front end and pharmacy ordering by ordering expense items. Monitors pharmacy manual orders to identify excess orders. Maintains consigned inventory and orders as required. + Ensures all designated pull & quarantine item on-hands are updated and placed in the designated holding area. + Maintains accurate inventory counts. Maintains the accuracy of on-hand quantities including but not limited to basic departments, stockroom, overstock locations. + Under the supervision of the pharmacist-in-charge, maintains accurate inventory counts and accuracy of on-hand quantities in pharmacy and completes pharmacy smart counts. + Ensures the store maintains inventory compliance with state and local laws regarding regulated products (e.g., alcoholic beverages and tobacco products). + Assists in the maintenance of inventory records, including receiving and posting of all products (in the front-end)) received at the store in all inventory systems. Organizes files and retains all invoices/receipts/return authorizations necessary for all inventory activities. + Helps to prepare for physical inventory and supports the physical inventory day activities, including but not limited to preparing sales floor, stockroom, and pharmacy for inventory and auditing the third party team on the day of inventory. + Supports keeping all counters and shelves clean and well merchandised. + Knowledgeable of all store systems and equipment. + Assists and coaches store team on all package delivery activities, including scanning in and out of packages, completing all daily inventory functions and, package returns at Walgreens. Supports execution of Pickup Program. + In designated stores, when serving as the leader on duty, responsible and accountable for registering all related sales on assigned point-of-sale system (POS), including records of scanning errors, price verifications, items not on file, price modifications, and voids. Completes product returns, order voids, customer refunds, cash drops to safe, and provides change as requested for point of sale. + Complies with all company policies and procedures; maintains respectful relationships with coworkers. + Completes any additional activities and other tasks as assigned. **Training & Personal Development** + Attends company-based trainings for continuous development and completes all e-learning modules including safety training requirements. + Obtains and maintains a valid pharmacy license/certification as required by the state. **Communications** + Serves as a liaison between management and non-management team members by coaching and developing other capabilities with inventory systems. When serving as the leader on duty, communicates assigned tasks to team members and reports disciplinary issues and customer complaints to management. **Job ID:** 1575155BR **Title:** Inventory Specialist **Company Indicator:** Walgreens **Employment Type:** Part-time **Job Function:** Retail **Full Store Address:** 3445 S HIGH ST,COLUMBUS,OH,43207 **Full District Office Address:** 3445 S HIGH ST,COLUMBUS,OH,43207-03693-01317-S **External Basic Qualifications:** + Six months of prior work experience with Walgreens (internal candidates) or one year of prior retail work experience (external candidates). + Must be fluent in reading, writing, and speaking English (except in Puerto Rico). + Must have a willingness to work a flexible schedule, including evening and weekend hours. + "Achieving expectations" rating on last performance review and no written disciplinary actions in the previous 12 months (internal candidates only). + Demonstrated attention to detail and ability to multi task and manage execution. + Experience in identifying operational issues and recommending and implementing strategies to resolve problems. **Preferred Qualifications:** + Prefer previous experience as a shift lead, pharmacy technician, designated hitter, or customer service associate. + Prefer to have prior work experience with Walgreens, with an evaluation on file. We will consider employment of qualified applicants with arrest and conviction records. **An Equal Opportunity Employer, including disability/veterans.** The actual compensation that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits . If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits **Shift:** Various **Store:** 01317-COLUMBUS OH

You could be the one who changes everything for our 28 million members as an Intern at Centene. During this 12-week program, you'll learn more about Centene and how we're transforming the health of the community, one person at a time. Observe preceptors and participate in various projects to learn and develop skills related to the Managed Care industry. + Develop clinical knowledge and skills by learning about various processes and functions within the Managed Care industry + Observe processes and shadow preceptors to gain hands on experience and become familiar with various clinical services + Follow instructions and procedures provided by preceptor or manager in accordance with company guidelines **Education/Experience:** Current enrollment in an accredited clinical program. Candidates must be receiving course credit for participating in the Externship program. Unpaid. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act