Job Summary
Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
Knowledge/Skills/Abilities
• Provide non-clinical operational support for Long Term Services & Supports (LTSS) coordination.
• Make follow up calls to members after authorizations to be sure that services have begun and/or adaptive devices have been delivered and member is satisfied.
• Review home modification needs and interface with contractors regarding the bidding process; follow up after home modifications are completed; and notify the care coordinator of issues regarding the home modification process.
• Authorize and coordinates delivery of durable medical equipment and/or supplies for members transitioning out of the nursing home, under the direction of the Care Coordinator.
• Enter authorizations into QNXT system as required.
• Measure and track activities occurring during process and report results to the supervisor.
• Establish and maintain relationships with Providers in assigned market.
• Follow up and notify providers of problems with supplies and services and communicate back to the care coordinator/supervisor any issues and resolutions.
• Initiates referral for Medicare and Waiver process if member is not already Medicare or waiver established.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Attend outreach meetings as assigned.
• Other administrative functions as needed.
• Local travel - 15-20% of the time..
Job Qualifications
Required Education
HS Diploma or GED
Required Experience
• 1-3 years experience in an administrative support role in healthcare.
• Experience demonstrating ability to handle multiple work tasks, prioritize tasks, and excellent problem solving.
• Experience demonstrating strong communication skills.
Required License, Certification, Association
Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
Preferred Education
Associate's Degree
Preferred Experience
• 3+ years experience in an administrative support role in healthcare, Medical Assistant preferred.
• 2 years Long Term Care experience preferred and/or Managed Care experience.
• Fluency of second language highly desired.
Preferred License, Certification, Association
N/A
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.
United States
