JOB DESCRIPTION Job SummaryProvides support for member navigator activities. Responsible for telephonic liaison support to members navigating individual health care needs - identifies barriers to healthy outcomes and care, and ensures members have necessary support and resources to meet heath care goals. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
- Serves as member liaison throughout program life cycle - providing support and resources to members, and understanding of program benefits and resources available for desired health care outcomes.
- Communicates with members and caregivers to uncover and act on possible barriers to healthy outcomes - thereby safeguarding against unnecessary admissions, readmissions, urgent care and emergency department visits.
- Completes member welcome calls on date of notification of assignment and/or discharge.
- Manages appropriate and timely member appointment scheduling, confirmations and appointment reminders; mails letters as needed.
- Conducts and collaborates on action plan creation for member barriers.
- Identifies and connects member to resources for addressing social determinants of health (SDOH).
- Notifies all appropriate departments of data related member case updates.
- Outreaches to members/providers and inputs appointments into system.
- Follows program-specific quality measures and adheres to company guidelines and standard program operating procedures.
- Adheres to established guidelines for case closings.
- Outreaches to appropriate parties to report any benefit, authorization, claim or eligibility related issues.
- Prepares information for member case status summaries, success stories, etc. and participates in daily huddles, weekly meetings/other internal events, in addition to external member events.
- Prepares, communicates, and follows-through on member issues that require escalation communications to leadership.
- Reviews system related tasks and emails for management of daily responsibilities and ensuring effective and thorough management of all assigned member cases to completion.
- Maintains member outreach and daily activities for cases assigned to out of office member navigators and peers as directed by leadership.
- Documents all phone calls, interventions, appointments and other system related data member concerns, questions or complaints accurately.
- Consistently meets position key performance indicator (KPI) metrics as defined by leadership.
- Acts as liaison to internal and external customers to ensure prompt resolution of identified issues.
Required Qualifications• At least 2 years customer service, preferably in a health care setting, or equivalent combination of relevant education and experience.
- Excellent problem-solving, critical-thinking and organizational skills.
- Ability to prioritize, organize, plan and manage multiple tasks simultaneously.
- Working knowledge of medical/pharmacy terminology, state and National Committee for Quality Assurance (NCQA) guidelines.
- Ability to collaborate internally and externally with members, providers, team members and leaders.
- Ability to work in an independent manner with minimal supervision.
- Strong verbal and written communication skills, including professional phone etiquette.
- Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs.
Preferred Qualifications
- Working knowledge of medical terminology and health care landscape.
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
Pay Range: $13.41 - $29.06 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
