Jobs in the United States

25+ jobs

Group jobs by employerEmail me new jobs Save this search

Added just now
Director, Marketing Communications - Lincoln
Ford Motor Company
Detroit, MI
…requirements, and measurement frameworks that connect each program to Lincoln brand, vehicle, customer, and business…
Added just now
Applied AI Health System Engineer [Health Services-Provider] – Senior Manager
PwC
Detroit, MI · Grand Rapids, MI
What You Must Have
Added just now
MH
Program Manager, Health Plan Payment Integrity (MI)
Molina Healthcare
Detroit, MI
- $73,102 to $142,549 USD / year
Employee for this role must reside in Michigan
Added just now
Manager, Product Line Performance - Lincoln
Ford Motor Company
Detroit, MI
This position is hybrid with a requirement to be onsite four or more days per week
Added just now
Manager, Business Operations - Model e
Ford Motor Company
Detroit, MI
…builder, and proactive problem solver who excels at translating complex strategy into decisive operational…
Added just now
Customer Success Manager
Generac Power Systems
Detroit, MI
We are looking for a Customer Success Manager to join our energy team who believes in a cleaner energy future and wants to play a role in advancing that vision. You will work with a…
Added just now
Senior Manager, Commercial CRM
Ford Motor Company
Detroit, MI
The Senior Manager, Commercial CRM – Ford Pro is the CRM leader accountable for setting and championing the near- and long-term strategy, roadmap, and business case for Ford Pro's customer…
Added just now
Technology Demand Admin-Staff or Senior
Intermountain Health
Lansing, MI
The hiring manager is considering applicants who have experience working in a healthcare environment with an understanding of clinical workflows, patient care processes, and technology…
Added just now
Sr Project Manager- Strategic Implementations ACAS
CVS Health
Hartford, CT
Applies highly developed project management skills to effectively plan, execute. and monitor complex projects. ensuring alignment with organizational objectives.
Added just now
O
Strategic Planning and Organization Program Manager
Oracle
Lansing, MI
- $91,000 to $209,500 USD / year
Oracle Research Services is seeking a Strategic Planning and Organization Program Manager to support the Group Vice President. In this role, you will help translate leadership priorities…
Added just now
Senior Lead Marketing Manager
Lumen
Lansing, MI
The Senior Lead Marketing Manager will shape scalable, integrated marketing programs that translate business priorities, sales goals, and pipeline needs into measurable growth. Operating at…
Added just now
Project/Program Manager 10617MI
Io Datasphere, Inc.
Lansing, MI
Our client is looking for a Project Manager to lead multiple Information Technology (IT) programs and projects. Projects/programs are primarily complex enterprise initiatives related to IT…
Added just now
AT
Senior Product Manager - Devices Segmentation
Akamai Technologies, Inc.
Lansing, MI
- $139,300 to $250,700 USD / year
As a Product Manager, you will be responsible for:
Added just now
Program/ Project Manager
V2soft Inc.
Lansing, MI
Added just now
Project Manager 2
HTC Global Services Inc
Lansing, MI
Job Title: Senior IT Project Manager – Enterprise IT Initiatives Position Overview
Added just now
AT
Technical Program Manager II
Akamai Technologies, Inc.
Lansing, MI
- $100,700 to $181,300 USD / year
As a Technical Program Manager II, you will have end-to-end accountability for the delivery of assigned projects and programs. You will lead complex, cross-functional initiatives from…
Added just now
RN Care Manager
Intermountain Health
Lansing, MI
The RN Hospital Care Manager I delivers comprehensive care management services to designated patients, leveraging clinical expertise for screenings, assessments, and evaluations. This role…
Added just now
RN Care Manager
Intermountain Health
Lansing, MI
The RN Hospital Care Manager I delivers comprehensive care management services to designated patients, leveraging clinical expertise for screenings, assessments, and evaluations. This role…
Added just now
Lead Technical Program Manager
Ford Motor Company
Dearborn, MI
…development and disciplined execution. You will guide technical program managers and integration analysts, bring clarity to complex dependencies, and ensure teams understand how their work…
Added just now
Quality Manager (Mgr Quality 2) - 28646
HII
Alma, MI
What You Must Have · Candidate must have direct experience with commercial nuclear quality programs and manufacturing of structural steel components
Added just now
U
Senior Business Program Manager (2 year Fixed Term)
USP
Rockville, MD
- $100,042 to $142,430 USD / year
The Business Program Manager supports the planning, coordination, execution, and continuous improvement of cross-functional programs and strategic initiatives that advance organizational…
Added 1 min ago
CH
Pharmacy Technician
CVS Health
Lino Lakes, MN
- $17 to $27 USD / hour
As a new Pharmacy Technician, you are required to complete an extensive CVS Pharmacy Technician Training Program as well as satisfy all registration, licensing and certification…
Added 2 mins ago
Associate Director - Cost Manager / Quantity Surveyor
Turner & Townsend
New Albany, OH
To be successful in this role, you must have excellent communication skills and be comfortable operating in a client-facing environment
Added 2 mins ago
Senior Cost Manager / Quantity Surveyor
Turner & Townsend
New Albany, OH
Turner & Townsend is seeking an experienced Senior Cost Manager / Quantity Surveyor to support the delivery of complex construction projects and capital programs. This client-facing role…
Added 2 mins ago
Cost Manager / Quantity Surveyor
Turner & Townsend
New Albany, OH
Turner & Townsend is seeking a Cost Manager / Quantity Surveyor to support the delivery of complex construction projects and capital programs. This client-facing role will provide cost…

Molina Talent Acquisition

Program Manager, Health Plan Payment Integrity (MI)

Detroit, MI, United States

Apply on hckd.fa.us2.oraclecloud.com About employer

Applications open in a new tab.

Job details

Work location: ***Employee for this role must reside in Michigan***
Posting language: English
Posted: Nov 10, 2026

Original job description

JOB DESCRIPTION

***Employee for this role must reside in Michigan***

Job Summary

Provides subject matter expertise for oversight, production, and resolution of health plan payment integrity (PI) recovery concepts. Executes and monitors health plan scoreable action items (SAIs) to ensure performance and quality levels exist in PI Business products and processes. Establishes procedures and techniques to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits and overpayment recovery. Manages inventory and works in collaboration with PI team to ensure SAI targets are met. Makes independent and informed decisions that contribute to health plan strategy, and acts as a trusted voice in resolving complex business challenges that impact cost-containment and regulatory compliance.

Essential Job Duties

Business Leadership & Operational Ownership
Independently owns and manages scorable action items (SAIs), including assisting and executing projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery, to improve encounter submissions, reduce general and administrative (G&A) expenses, and drive positive operational and financial outcomes for all payment integrity (PI) solutions.
Independently leads efforts to improve claim payment accuracy, claim referrals, adjustment analysis and financial performance.
Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
Serves as a thought partner to health plan leadership, and provides well-reasoned recommendations that support short- and long-term business goals.
Partners with the network team to communicate recovery projects to ensure provider relations is informed and able to respond to provider inquiries.

Strategic Business Analysis

Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps.
Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment integrity related recommendations and action plans.
Translates strategic needs into clear requirements, workflows, and solutions that drive measurable improvement.
Partners with finance and compliance to develop business cases, and support reporting that ties operational outcomes to financial targets.

Applied Analytical Support

Uses data analysis tools/systems to support business analysis.
Validates findings and test assumptions through data, and leads with contextual knowledge of claims processing, provider contracts, and operational realities.
Creates succinct data summaries and visualizations that enable faster leadership decision-making.

Required Qualifications

At least 5 years of business analyst experience in a managed care organization (MCO), and at least 3 years of experience in Medicaid and/or Medicare programs, or equivalent combination of relevant education and experience.
Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity.
Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules.
Strong data analysis/queries experience, and ability to analyze data to inform business decisions.
Strong business judgment, cross-functional coordination, and ownership of high-value deliverables.
Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment.
Strong written and verbal communication skills, including ability to synthesize complex information.
Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency.

Preferred Qualifications

Experience with Medicare, Medicaid, and/or Marketplace lines of business.
Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) certification.
Project management experience.
Familiarity with Medicaid-specific scorable action items (SAIs), operational cost-management efforts, payment integrity (PI) programs, and regulatory/compliance adherence.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Apply on hckd.fa.us2.oraclecloud.com About employer

More about this job

Skills

CMS
Collaboration
Regulatory compliance
Leadership
Business analysis
Reporting
Data analysis
Claims processing
Decision making
CPT
HCPCS
Work independently
Communication skills
Microsoft Office
Microsoft Excel
Project management
Cost management

Report this job

Work requirements

Jobs in the United States