Healthcare - Case Management Processor

Job Title

Molina Healthcare Services Case Management Processor

Location: Must live in MI (Preferably near Detroit, but really anywhere in Wayne or Macomb County) - role is 90% remote and 10% field work

Hours: 8:30am to 5pm EST

Possible temp to hire

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

• Basic computer skills (e.g. Microsoft Office)
• Proficiency in data analysis tools (e.g. Microsoft Excel)
• Ability to manage files, schedules and information efficiently
• Phone communication skills
• Internet that will support Molina internal systems
• Provides telephone, clerical, and data entry support for the Case Management team.
• Responsible for initial review of assigned case levels to assist in Case Management assignment.
• Reviews data to identify principal member needs and works under the direction of the Case Manager to implement care plan.
• Schedules member visits with team members as needed.
• 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.
• Processes member and provider correspondence.

This position will be outreach members to engage and help to close out quality gaps, along with transferring calls to a phone queue where a Care Manager can assist in completing an assessment and care plan with the member. The case management processor will also be working in chart retrieval projects, calling provider offices, faxing, reviewing/scrubbing/renaming and uploading charts, researching provider office and member information in internal and external systems. Collaborating with team to meet deadlines and timelines for projects with high visibility. Could include onsite visits to collect medical records.

Job Qualifications

• Required Education: HS Diploma or GED
• Required Experience: 1-3 years' experience in an administrative support role in healthcare.
• Preferred Education: Associate degree
• Preferred Experience: 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred, basic knowledge of HEDIS and NCQA
• Must have a valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation