Provides support to Case Management staff performing non-clinical activities and supporting department management.
Performs initial review and triage of Case Management tasks.
Reviews data to identify member needs and assists the Case Manager in implementing care plans.
Coordinates required services in accordance with member benefit plans and promotes communication with healthcare providers and team members.
Job description
• Will the position be 100% remote? Yes • Are there any specific location requirements? WASHINGTON (outside greater-Seattle) • Are there are time zone requirements? PST • What are the must have requirements? 2+ years of customer services experience, proficient in Microsoft office applications, comfortable being on phones. • What are the day to day responsibilities? Outbound calls, emails, and processing of unable to contact requests. • Is there specific licensure is required in order to qualify for the role? N/A • What is the desired work hours (i.e. 8am – 5pm)- 8am – 5pm • What additional equipment besides a laptop, keyboard, mouse and headset will be required for this candidate to be successful in this role? 2 monitors
Duties and Responsibilities (List all essential duties and responsibilities in order of importance) Provides support to the Case Management staff performing non clinical activities and supporting the management of the department. Responsible for initial review and triage of Case Management tasks. Reviews data to identify principle member needs and works under the direction of the Case Manager to implement care plan. Screens members using Molina policies and processes assisting clinical Case Management staff as they identify appropriate medical services Coordinates required services in accordance with member benefit plan. Promotes communication, both internally and externally to enhance effectiveness of case management services (e.g., health care providers and health care team members). Runs reports to assist in coordination of case management needs. Provides support services to case management team members by answering telephone calls, taking messages and researching information. Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. Protects the confidentiality of member information and adheres to company Knowledge, Skills and Abilities ( List all knowledge, skills and abilities that are necessary to perform the job satisfactorily) Strong customer service skills to coordinate service delivery including attention to members/customers, sensitivity to concerns, proactive identification and resolution of issues to promote positive outcomes for members Demonstrated ability to communicate, problem solve, and work effectively with people Working knowledge of medical terminology and abbreviations Ability to think analytically and to problem solve. Good interpersonal/team skills Must have a high regard for confidential information Ability to work in a fast paced environment Able to work independently and as part of a team. PC experience in Windows environment and accurate data entry at 40 WPM minimum. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
Required Education: High School Diploma or G.E.D.
Required Experience: Two or more years experience as a medical assistant, office assistant or other healthcare service administrative support role.
