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Member Navigator

3 months ago

Long Beach, California, United States Molina Healthcare Full time
Job Description

JOB DESCRIPTION

Job Summary

The Member Navigator primary function is to be the member's liaison. Primarily telephonic, this role is responsible for ensuring that the members member has assistance they may need in navigating their health care needs. Throughout the duration of services, the Member Navigator will communicate with members and caregivers to uncover and act on possible barriers to a healthy outcome, thereby safeguarding against unnecessary admissions, readmissions, urgent care, and emergency department visits.

KNOWLEDGE/SKILLS/ABILITIES
  • Strong working knowledge of medical terminology and healthcare landscape preferred
  • Excellent written and verbal communication skills to collaborate internally and externally with members, providers, team members, and manager
  • Work in an independent manner with minimum supervision
  • Excellent problem solving, critical thinking, and organizational skills
  • Must be organized and able to prioritize, plan, and handle multiple tasks simultaneously
  • Serve as the member's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures
  • Make all member welcome calls on date of notification of assignment and/or discharge. Make appropriate and timely member appointments, confirmations, and appointment reminders. Mail letters as needed
  • Complete telephonic visits with members utilizing current standard operating procedures
  • Notify all appropriate departments of data related member case updates
  • Outreach to members/members providers and input appointments
  • Adhere to established guidelines for case closings
  • Identify and connect member to resources for addressing Social Determinants of Health (SDOH) by utilizing resources from the Health Plan and Aunt Bertha
  • Outreach to the appropriate party to report any benefit, authorization, claim or eligibility related issue
  • Prepare information for member case status summaries, success stories, etc. and participate in daily huddles, weekly meetings, and other scheduled events, internally, and with members externally
  • Prepare, communicate, and follow through on member issues that require escalation communications to management
  • Conduct and collaborate on creating action plans for member barriers
  • Review system related tasks and email instructions throughout the day for management of daily responsibilities to manage all assigned member cases effectively and thoroughly to completion
  • Maintain member outreach and daily activities for cases assigned to out of office Member Navigators and peers as directed by leadership team
  • Document accurately all phone calls, interventions, appointments and other system related data member concerns, questions, or complaints
  • Consistently meet position Key Performance Indicator metrics as defined by leadership
  • Other duties as assigned by leadership may exist to meet business needs.
  • Bilingual (English/Chinese, Korean or Vietnamese)
JOB QUALIFICATIONS

Required Education

High School Diploma or GED required

Required Experience

2+ years of customer service and/or healthcare experience in a fast-paced environment

Preferred Education

Associate Degree or higher from an accredited college preferred

Preferred Experience
  • Computer proficiency to include typing, data entry, internet research, and spelling accuracy
  • Proficient with Microsoft Office applications including Word, Excel and PowerPoint
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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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