needs 1 extra monitor
• Will the position be 100% remote?- yes
• Are there any specific location requirements?- Candidates need to be located in 1 of the following 15 states: AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle), WI
• Are there are time zone requirements? – M-F 8- 5 PM PST
• What are the must have requirements? – Knowledge of Managed Care (Utilization Management or Claims), Microsoft Excel and related Microsoft applications.
• What is the day to day responsibilities?-
Responsible for tracking IPA reports, educating and communicating with delegated groups, and ensuring the correct team has the necessary files for manual entry into the system. This role involves troubleshooting delegate issues with report submissions and addressing reporting problems.
• Track IPA Reports: Monitor and manage the receipt of IPA reports.
• Communication and Education: Send emails and provide education to groups regarding the submission of reports.
• File Management: Ensure the correct team has the required files for manual entry into the system.
• Claims Tracking: Track pending claims and provide education to delegated groups.
• Troubleshooting: Address and resolve delegate issues with report submissions and reporting problems.
• Is there specific licensure is required in order to qualify for the role? -No
• What is the desired work hours (i.e. 8am – 5pm)- 8am-5pm PST
Summary: Responsible for intermediate to large scale projects and project teams made up of internal and external resources to deliver business solutions and services to the department. Interacts closely with internal staff, external corporate departments, and Health Plans to define the project parameters and develop detailed project documentation to include business requirements, project plans, project schedules, workflow solutions, and project status reports/communications. Projects may vary to include the following: system implementations, internal/cross functional department process improvement initiatives, implementation of new state health plans, and implementation of new product lines. Essential Functions: Manages all aspects of assigned projects throughout the development project lifecycle including project scope, schedule, resources, quality, costs and change. Develop and maintain 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. Conducts regularly scheduled project status update meetings. Develop process workflows as it relates to assigned projects and/or to support internal process improvement initiatives. Interfaces, when appropriate, with all areas affected by the project to include internal subject matter experts, external corporate departments, and Health Plans. Act as a liaison for department on enterprise wide projects. Collaborates well with all levels of personnel within the company; and provides exemplary customer service. Complies with required workplace safety standards. Knowledge/Skills/Abilities: Ability to assimilate and articulate simple business solutions and project approaches Strong interpersonal skills Strong verbal and written communication skills Intermediate knowledge of Microsoft applications (Word, Excel, Project, PowerPoint, Visio) Ability to be flexible while adapting quickly to change Ability to work independently as well as within a team Analysis, synthesis, and problem solving skills Deductive and inductive thinking skills Attention to detail and accuracy Demonstrated ability to make effective business decisions Ability to successfully manage intermediate- to large-scale projects using a prescribed approach. Ability to develop detailed project plans, communication plans, schedules, role definitions, risk management, and assumptions. Ability to create project management deliverables such as WBS, schedule, roles & responsibilities document, meeting agendas/minutes, issues and action items tracking. Identifies obstacles to project success; presents alternatives to manage/overcome obstacles. Ability to multi-task and prioritize workload. Demonstrate knowledge of health plan operations and major healthcare technology applications Ability to clearly articulate the primary functions in a health plan and the major health plan sub-processes and key roles, and their interaction Ability to clearly articulate the differences between health plan product lines Demonstrate knowledge of key health plan operational and financial performance metrics Ability to abide by Molinas policies Ability to maintain attendance to support required quality and quantity of work Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers Required Education: Bachelors degree Required Experience: 2-4 years formal project management experience 2-4 years systems implementation
