Will the position be 100% remote? Yes
Are there any specific location requirements? Must reside in CA
Are there are time zone requirements? Pacific Time
What are the must have requirements? Must have Call Center outreach experience and Bilingual (Spanish) speaking preferred, Health plan or medical office experience is a plus, Appointment scheduling experience is a plus.
Is there specific licensure is required in order to qualify for the role? No
What are the desired work hours (i.e. 8am – 5pm): 8:30am -5:30pm PST; 9:00AM -6:00pm PST, must be available to work weekends as needed.
Provides general administrative support that includes routine document preparation, file management, scheduling/arranging meetings, arranging travel and ordering office supplies. May also perform a variety of activities in support of the functional processes, programs and/or services. Also provides the administration of various programs, projects and assignments aligned with functional processes and services.
• Handling inbound /outbound Member and Provider calls
• Member's Eligibility verification
• Schedule Appointments for Members to receive care
• Generate Unable to Contact Letters and Appointment Reminder Letters
• Outreach to Provider's offices for scheduling, member information, or other requests as
needed
• Track all calls in Salesforce
• Assist with transportation, language assistance, and other member benefits
• Perform appointment reminder calls
• Follow department processes and procedures for scheduling, documentation, outreach, etc.
• Comply with state, federal and accreditation requirements
• Assists in planning and organizing project activities.
• Collaborates with internal and external parties to assist with organizing the various components needed to initiate, run and conclude major projects.
• Retrieves data from a variety of sources for the purpose of complying with financial, legal and/or administrative requirements.
• Identifies and reports departmental operational issues and resource needs to the appropriate management personnel.
• Presents information on administrative department procedures, services, regulations, etc. for the purpose of orienting other personnel and/or disseminating information to appropriate parties.
Summary: Responsible for the assessment and review, coordination and distribution of review decisions for members identified with medical, surgical, and long-term care, needs including home and community-based waiver recipients. Interacts with Medical Directors, HCS department staff, various other Molina staff and providers and practitioners to ensure timely receipt of decisions in accordance with Molina policies, procedures and processes. Adheres to the company/departments confidentiality and HIPAA compliance programs. Adheres to the company/departments fraud and abuse prevention/detection policies and programs. Essential Functions: Provides various care coordination activities in collaboration with the clients managed care organization (MCO), health care providers, other HCS staff, involved medical case managers/care coordinators, public agencies, and other providers as required. Documents all findings, contacts and interventions. Maintains case-specific communication with state agencies, healthcare individuals and support systems to promote efficient and well-coordinated quality care. Provides scheduled assessment and review of health needs, individualized care plans, and monitoring of Medicaid eligibility. Confers with appropriate staff, including, but not limited to, case managers/care coordinators, medical directors, social workers, health care providers and practitioners, and state agency staff to provide timely and accurate service authorizations and reviews based on a recipients current needs/functioning. Communicates review decisions and prior authorizations to various professionals involved in the clients care, including practitioners and primary care providers (PCP). Shared responsibilities for professional responses to client, provider and practitioner, and state agencies via telephone. Assists other department team clients when needs are identified. Establishes and maintains professional rapport with providers, clients, public agencies, and others involved in the clients care. Knowledge/Skills/Abilities: Must have strong oral and written communications skill to ensure accurate exchange of information and to build rapport that will ensure the trust, confidence and cooperation of others in a work situation Must have the skills to learn and adapt to company policies and procedures as they relate to hospital authorization/denials, physician review, appeals, etc. Must have the ability to successfully apply established guidelines and regulation to individual and specific situations Must have excellent organization skills to establish and maintain a variety of records necessary to provide complete and accurate information and documentation for relevant and appropriate medical determination Ability to perform independently and to handle multiple projects simultaneously Must have excellent interpersonal skills Must be PC literate (Microsoft Office) and able to work in multiple database/systems simultaneously Excellent verbal and written communication skills Ability to abide by Molinas policies Maintain regular attendance based on agreed-upon schedule 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: Bachelors Degree in a health care related field (Relevant experience will be considered in lieu of degree). Required Experience: 0-2 years clinical experience or equivalent combination of education and experience.
