Sr Case Management Processor

Molina Healthcare; Honolulu (HI); On-site; USD 20,333 - 44,041; Full time

Benefits offered by this job

Competitive benefits

EOE

Job summary

Molina Healthcare in Honolulu is seeking a Case Manager to coordinate care for members at risk for high cost and high utilization, collaborating with members and providers across the care continuum.

The role focuses on leading initiatives to reduce costs and improve quality, developing and implementing programs, and aiding in budgeting and regulatory responses.

Qualifications

• Requires Associate's Degree or equivalent.
• 1–3 years of experience required.
• Preferred Bachelor’s Degree or 3–5 years of experience.

Responsibilities

• Provides support to department staff by performing non-clinical activities.
• Initial review and triage of Case Management tasks.
• Reviews data to identify principal member needs and helps implement a care plan.
• Coordinates required services in accordance with member benefit plans.
• Promotes communication, internally and externally, to enhance effectiveness of case management services.

Skills

Communication

Case management

Collaboration

Triage

Education

Associate's Degree

Bachelor's Degree

Job description

Job Summary

Responsible for working with members and providers to assess, facilitate, plan and coordinate the delivery of care across the continuum for members with potential risk for high cost and high utilization.

Responsible for leading project initiatives aimed at reducing the cost of care and improving quality. Oversees the development and implementation of new programs, processes, and practices in response to medical, operational, service, and regulatory initiatives. Identifies utilization management information needs and technologies. Develops and manages the annual operating budget within financial objectives.

Responsibilities and Knowledge/Skills

• Provides support to the department staff by performing non‑clinical activities.
• Initial review and triage of Case Management tasks.
• Reviews data to identify principal member needs and works under the direction of the Case Manager to implement a care plan.
• Coordinates required services in accordance with member benefit plans.
• Promotes communication, both internally and externally, to enhance effectiveness of case management services.

Qualifications

• Required Education: Associate's Degree or equivalent combination of education and experience.
• Required Experience: 1‑3 years.
• Preferred Education: Bachelor's Degree or equivalent combination of education and experience.
• Preferred Experience: 3‑5 years.

Benefits

Molina Healthcare offers a competitive benefits and compensation package.

Pay Range: $14.76 - $31.97 / HOURLY. Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.