Lead Member Navigator

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.

Job Duties

Acts as a trainer and mentor to new team membersServe as the subject matter expert for the Member Navigators throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating proceduresEnsures the team members conducts member welcome calls on date of notification of assignment and/or discharge. Make appropriate and timely member appointments, confirmations, and appointment reminders and assist the team in meeting their daily goalsCompletes and assists team members with telephonic contacts with members utilizing current standard operating proceduresNotify all appropriate departments of data related member case updates. Ensures the team is completing case updates in a timely fashionOutreach to members/members providers and input appointments and assist team members with complex cases to create successful outcomesAdhere to established guidelines for case closings. Hold team accountable to adhere to the same guidelinesIdentify and connect member to resources for addressing Social Determinants of Health (SDOH) by utilizing resources from the Health Plan and Community for Me. Assist team members in site navigation to provide member resourcesEscalate to the appropriate party to report any identified benefit, authorization, claim or eligibility related issuePrepare information for member case status summaries, success stories, etc. and participate and possibly lead in daily huddles, weekly meetings, and other scheduled events, internally, and with members externallyPrepare, communicate, and follow through on member issues that require escalation communications to management and outside partnersProblem solve and collaborate with external and internal stakeholders on creating action plans for member barriersReview system related tasks and email instructions throughout the day for management of daily responsibilities in order to effectively and thoroughly manage all assigned member cases to completionMaintain member outreach and daily activities for cases assigned to out of office Member Navigators and peers as directed by leadership teamDocument accurately all phone calls, interventions, appointments and other system related data member concerns, questions or complaintsConsistently meet position Key Performance Indicator metrics as defined by leadershipOther duties as assigned by leadership may exist to meet business needs

Job Qualifications

REQUIRED EDUCATION: High School Diploma or GED required

Required Experience

4+ years of customer service and/or healthcare experience in a fast-paced environmentStrong working knowledge of medical terminology and healthcare landscapeExcellent written and verbal communication skills to collaborate internally and externally with members, providers, team members, and manager Work in an independently manner and leads the Member Navigators to completion of daily goalsExcellent problem solving, critical thinking, and organizational skillsMust be organized and able to prioritize, plan, and handle multiple tasks simultaneously

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

Physical Demands

Work environment is generally favorable, and lighting and temperature are adequate for home office workspace. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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.

Pay Range: $14.76 - $31.97 / HOURLY

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.