Navigator, Healthcare Access - Long Beach, CA ONLY

Molina Healthcare; Long Beach (CA); On-site; USD 18,000 - 40,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare in Long Beach, CA is seeking a Member Navigator Support role to assist members navigating health care needs by providing telephonic liaison and resource connections.

The position focuses on reducing unnecessary hospital visits, coordinating appointments, addressing social determinants of health, and reporting updates to internal teams, while adhering to quality measures and program guidelines.

Qualifications

• At least 2 years of customer service experience, preferably in health care.
• Excellent problem-solving, critical-thinking and organizational skills.
• Ability to prioritize, plan and manage multiple tasks.
• Working knowledge of medical/pharmacy terminology and NCQA guidelines.
• Ability to collaborate with members, providers, and leaders.
• Ability to work independently with minimal supervision.
• Strong verbal and written communication skills.
• Proficiency with Microsoft Office and related software; able to learn new programs.

Responsibilities

• Serves as member liaison throughout program life cycle, providing support and resources to members.
• Communicates with members and caregivers to uncover barriers to healthy outcomes.
• Completes member welcome calls on assignment or discharge.
• Manages appointment scheduling, confirmations and reminders.
• Creates action plans for member barriers.
• Identifies and connects members to resources addressing social determinants of health.
• Notifies departments of data-related member case updates.
• Inputs appointments and outreaches to members/providers in the system.
• Follows program quality measures and company guidelines.
• Escalates member issues to leadership as needed.
• Documents calls and case notes accurately.
• Meets KPI metrics and acts as liaison to customers.

Skills

Customer service

Problem-solving

Organizational skills

Prioritization

Communication skills

Medical terminology

NCQA guidelines

Independence

Tools

Microsoft Office

Job description

JOB DESCRIPTION Job Summary

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.

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.