Provides 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.
• 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.
• 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
Job details are sourced from the employer's original posting.
Open job postingAbout the company
Molina Talent Acquisition is the recruiting arm of Molina Healthcare, focused on finding and hiring talent for the organization.