Job Description

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.

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

EMR - EPIC

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