JOB DESCRIPTION
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
- Serves as a community based member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing their healthcare needs.
- Collaborates with and supports the Healthcare Services team by providing non-clinical paraprofessional duties in the field, to include meeting with members in their homes, nursing homes, shelters, or doctor's offices, etc.
- Empowers members by helping them navigate and maximize their health plan benefits.
- Assistance may include: scheduling appointments with providers; arranging transportation for healthcare visits; getting prescriptions filled; and following up with members on missed appointments.
- Assists members in accessing social services such as community-based resources for housing, food, employment, etc.
- Provides outreach to locate and/or provide support for disconnected members with special needs.
- Conducts research with available data to locate members Molina Healthcare has been unable to contact (e.g., reviewing internal databases, contacting member providers or caregivers, or travel to last known address or community resource locations such as homeless shelters, etc.)
- Participates in ongoing or project-based activities that may require extensive member outreach (telephonically and/or face-to-face).
- Guides members to maintain Medicaid eligibility and with other financial resources as appropriate.
- 50-80% local travel may be required. Reliable transportation required.
JOB QUALIFICATIONS
REQUIRED EDUCATION:
HS Diploma/GED
REQUIRED EXPERIENCE:
• Minimum 1 year experience working with underserved or special needs populations, with varied health, economic and educational circumstances.
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
• Must have valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation.
• For Ohio and Florida only -- Active and unrestricted Community Health Worker (CHW) Certification.
PREFERRED EDUCATION:
Associate's Degree in a health care related field (e.g., nutrition, counseling, social work).
PREFERRED EXPERIENCE:
• Bilingual based on community need.
• Familiarity with healthcare systems a plus.
• Knowledge of community-specific culture.
• Experience with or knowledge of health care basics, community resources, social services, and/or health education.
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
• Current Community Health Worker (CHW) Certification preferred (for states other than Ohio and Florida, where it is required).
• Active and unrestricted Medical Assistant Certification
STATE SPECIFIC REQUIREMENTS: OHIO
• MHO Care Guide serves as a single point of contact for care coordination when there is no CCE, OhioRISE Plan, and/or CME involvement and short term care coordination needs are identified MHO Care Guide Plus serves as a single point of contact at Molina for care coordination when there is CCE, OhioRISE Plan, and/or CME involvement and short term care coordination needs are identified.
• Assures completion of a health risk assessment, assisting members to remediate immediate and acute gaps in care and access. Assist members with filing grievances and appeals.
• Connects members to CCEs, the OhioRISE Plan,or Molina Care Management if the members needs indicate a higher level of coordination. Provide information to members related to Molina requirements , services and benefits .
• Knowledge of internal MCO processes and procedures related to Care Guide responsibilities required
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.
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