Member Navigator -Bilingual (English/Spanish, Chinese, Vietnamese))

21 Sep 2024
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JOB DESCRIPTIONJob SummaryThe 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/Spanish, Vietnamese, Chinese)

JOB QUALIFICATIONSRequired EducationHigh School Diploma or GED requiredRequired Experience2+ years of customer service and/or healthcare experience in a fast-paced environmentPreferred EducationAssociate Degree or higher from an accredited college preferredPreferred 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.#PJCorpPay Range: $13.41 - $29.06 / HOURLYActual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Full-time
  • ID: #52558138
  • State: Kentucky Covington 41011 Covington USA
  • City: Covington
  • Salary: USD TBD TBD
  • Showed: 2024-09-21
  • Deadline: 2024-11-20
  • Category: Et cetera
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