Jobs

JOB DESCRIPTION Job SummaryProvides support for medical records collection activities. Supports quality improvement activities through outreach to providers for collection of medical records for Healthcare Effectiveness Data and Information Set (HEDIS) specific data collection, projects and audit processes. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Outreaches to providers via phone call, fax, mail, electronic medical record system retrieval and direct on-site pick up for collection of medical records. • Loads medical records …

Job Description Job Summary Provides support for medical claim and internal appeals review activities – ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. Job Duties Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing …

IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long-term health care needs? Then TMG wants to hear from you! We’re currently looking for someone with a social services or human services background to join our team. This is a remote position, where you will partner with people in your community who are enrolled …

ELIGIBILITY SCREENER, TMG Job Description Job Summary TMG is on the lookout for our next great Eligibility Screener! If you love doing meaningful work that helps others live their best lives, we want to hear from you! We’re currently in search for someone with a background in human services, social work, healthcare or case management to join our team. This is a remote position, where you will partner with people in your community who use the TMG IRIS Consultant Agency. …

IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long-term health care needs? Then TMG wants to hear from you! We’re currently looking for someone with a social services or human services background to join our team. This is a remote position, where you will partner with people in your community who are enrolled …

JOB DESCRIPTION Job Summary Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. Essential Job Duties • Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina …

JOB DESCRIPTION Job SummaryProvides support for critical incident management activities, including provision of critical incident management referral support to members. Strives to ensure member progress toward desired outcomes in conjunction with interdisciplinary team facilitating integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Reviews, monitors and provides recommendations for next steps related to member critical incidents. • Monitors compliance with critical incident related best practices and quality …

IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long-term health care needs? Then TMG wants to hear from you! We’re currently looking for someone with a social services or human services background to join our team. This is a remote position, where you will partner with people in your community who are enrolled …

Job Description Job Summary Makes outbound calls to members, completes assigned hand-dial lists, and provides proactive member support, information, and assistance. Adheres to member interaction departmental standards, call quality, and documentation requirements. Job Duties Schedules high-quality member appointments daily to meet departmental goals. Completes assigned hand-dial lists and member research requirements with accuracy and efficiency. Provides basic support and guidance to members with empathy and professionalism. Participates in ongoing training sessions to enhance service quality and knowledge. Job Qualifications REQUIRED …