Jobs at Molina Healthcare Inc.

Own and prioritize the HEDIS Engine and clinical data ingestion products end-to-end. Define product vision, maintain backlog, write user stories, lead Agile ceremonies, accept delivered work, ensure regulatory/compliance alignment, mitigate delivery risks, and collaborate with engineering, data, QA, operations, and health plan stakeholders.

Provide in-home and community-based consultation to IRIS participants, develop person-centered plans, connect participants with community resources, manage budgets and documentation in WISITs, ensure compliance and confidentiality, and collaborate with team members through regular meetings.

Provide remote IRIS consultation and care coordination for Wisconsin participants. Conduct required in-person visits, develop individualized long-term care plans, document activities in WISITs, connect participants to community resources, assist with budgeting and fiscal matters, ensure HIPAA compliance, and collaborate with team members through meetings and check-ins.

Entry-level analyst responsible for accurate loading, updating, and auditing of provider demographic and contract data across claims systems and provider databases to ensure correct claims processing, reporting, and directories.

Review, research, and resolve member and provider appeals, grievances, and claims denials in accordance with CMS, state, and Molina guidelines; communicate outcomes, prepare correspondence and summaries, request and review medical records, and identify root causes of payment errors.

Manage process improvement, organizational change, and project delivery including estimating, scheduling, costing, planning, and risk/issue management. Develop detailed project and communication plans, define roles, and use project-specific software. Support intermediate to large-scale projects with cross-functional teams and present alternatives to overcome obstacles.

Support compliance operations by managing Corrective Action Plans (CAPs) from initiation to remediation, analyze root causes and regulatory requirements, coordinate with business areas and regulators, maintain KPI and compliance reporting, interpret federal/state regulations, and manage compliance systems and CMS access.

Lead competitive intelligence and market analysis for RFP capture and response efforts across Medicaid, DSNP, and Marketplace lines. Build and maintain competitor content/scoring databases, support pre-RFP capture strategy, advise senior leadership, collaborate cross-functionally, support legal during award protests, and provide coaching for oral presentations. Travel 50%+.

Provide senior support for government contracts for Medicaid, Medicare and Marketplace programs. Review and prepare regulatory filings, ensure contractual and regulatory compliance of plan materials, coordinate with state agencies and internal teams, maintain documentation archives, and conduct evidence reviews and audits.

Analyze healthcare and operational datasets to produce and maintain reports, dashboards, and analytics using SQL, Excel, and BI tools. Validate data, document workflows, support regulatory reporting, and collaborate with stakeholders to deliver insights for utilization, cost containment, and performance improvement.

Lead cross-functional business programs from initiation through delivery: plan schedules and budgets, manage program staff and vendors, define requirements, create test plans and training materials, recommend process improvements, and monitor program performance. Acts as subject matter expert and supports Program Managers to meet critical organizational needs.

Lead a team overseeing operational controls, audits, compliance, and corrective actions across corporate operations. Liaise with regulators and auditors, manage CAPs, ensure regulatory alignment across states, support SIU and legal, and drive operational performance and improvement. Hire, train, and manage staff and may oversee financial/performance results for select operational units.

Designs and develops custom health plan reports for Risk and Quality/HEDIS, builds intervention and ad hoc reports, performs data analysis and QA using Databricks SQL, Power BI and Excel, conducts root cause analysis, tests data warehouse changes, and supports performance improvement projects.

Manage and supervise a configuration oversight team performing claims audits, ensuring timely, compliant audits and corrective actions. Liaise with stakeholders, develop policies/procedures, identify and mitigate regulatory risks, produce reports, and lead performance improvement and training activities.

Perform ongoing compliance audits to evaluate adherence to federal and state regulations, internal policies, and contract provisions; identify gaps, document findings, recommend corrective actions, and support risk assessment and monitoring of remediation.

Lead Databricks-based enterprise data and analytics modernization programs. Define future-state architecture, drive platform modernization, ensure security, scalability, cost optimization, and mentor teams while delivering AI-ready data platforms and governance.

Lead and supervise a team performing long-term care eligibility screenings (LTCFS), ensure compliance with program regulations, train and coach screeners, resolve screening issues, coordinate with stakeholders and physicians, produce data reports, and support quality improvement and certification maintenance.

Lead a finance and analytics team to perform financial modeling, forecasting, variance analysis, reserve review, vendor contract evaluation, and reporting. Collaborate with cross-functional teams, regulatory bodies, and enterprise analytics to improve profitability, data quality, and performance monitoring while supporting strategic planning and financial compliance.

Lead-level role supporting core operations: manage escalations, troubleshoot enrollment and claims issues, coordinate staffing and workflows, drive quality improvements, and provide SME guidance, training, and mentoring to team members.

Perform contract and targeted claim audits in QNXT to validate claim and provider data, ensure contracts and configurations are correct, identify coding or payment errors, track and report audit findings, recommend configuration or process changes, and collaborate with stakeholders to implement corrections.