Member Care Navigator

Molina Healthcare; Miami (FL); Hybrid; USD 33,000 - 64,000; Full time

Job summary

Molina Healthcare in Miami, FL is seeking a Care Coordination Specialist to support management of member care across the continuum. You will assess needs, develop care plans with the member and care team, and conduct visits as required to move toward outcomes.

The role requires at least 2 years in health care, a valid driver’s license, and the ability to travel regionally (25–40%). You’ll coordinate services, document interventions, and work independently in diverse settings while using Molina

Qualifications

• Requires 2+ years in health care, care management preferred.
• Driver's license, reliable transport, and auto insurance for travel.
• Knowledge of community resources.
• Strong communication and time-management skills.
• Ability to work independently and adapt to various settings.

Responsibilities

• Complete member assessments per regulated timelines.
• Develop and implement care plans with member, caregiver, physician and care team.
• Conduct telephonic, face-to-face or home visits.
• Monitor and adjust care plans based on outcomes.
• Maintain ongoing member caseload and outreach.
• Promote integration of services across behavioral health, LTSS, and home/community resources.
• Facilitate interdisciplinary care team (ICT) meetings.
• Use motivational interviewing and Molina guidelines to educate and motivate change.
• Assess for barriers to care and provide assistance to address concerns.
• Collaborate with licensed care managers as needed.
• Travel 25-40% may be required.

Skills

Communication

Time management

Interpersonal skills

Self-motivated

Detail-oriented

Education

Bachelor's degree (health care related)

Clinical licensure or certification

Tools

Microsoft Office Suite

Job description

JOB DESCRIPTION

Job Summary

Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.

Must reside in the following counties:

Region A: Escambia, Santa Rosa, Washington, Gadsden, Leon, Bay, Okaloosa, Walton, Wakulla, Jackson, Jefferson, Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Okaloosa, Santa Rosa, Taylor, Wakulla, Walton, Washington

Region B: Duval, Hernando, Lake, Marion, Volusia, Alachua, Columbia, St. Johns, Flagler, Citrus, Suwannee, Alachua, Baker, Bradford, Citrus, Clay, Columbia, Dizie, Duval, Flagler, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Nassau, Putnam, St John's, Sumter, Suwannee, Union, Volusia

Region C: Pasco, Pinellas

Region D: Hardee, Highlands, Hilssborough, Manatee, Polk - but highest volumes to be in Hillsborough, Manatee, and Polk

Region E: Seminole, Orange, Osceola, Brevard

Region F: Charlotte, Collier, Desoto, Glades, Hendry, lee, Sarasota) - but highest volumes to be in Collier, Lee, and Hendry

Region G: Indian River, Martin, Okeechobee, Palm Beach, and St Lucie )- but highest volumes in Palm Beach, St Lucie, Indian River, and Martin

Region H: Broward

Region I: Miami-Dade, Monroe

Essential Job Duties
• Completes assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments.
• Develops and implements care plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals.
• Conducts telephonic, face-to-face or home visits as required.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member caseload for regular outreach and management.
• Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
• Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
• Collaborates with licensed care managers/leadership as needed or required.
• 25- 40% estimated local travel may be required (based upon state/contractual requirements).

Required Qualifications
• At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.
• Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Demonstrated knowledge of community resources.
• Ability to operate proactively and demonstrate detail-oriented work.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and self-motivation.
• Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving and critical-thinking skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
• In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).

Preferred Qualifications

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

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Pay Range: $24 - $46.81 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.