Care Coordinator I
Molina Healthcare 191 reviews - New Mexico

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Job 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/department's confidentiality and HIPAA compliance programs. Adheres to the company/department's fraud and abuse prevention/detection policies and programs.
Essential Functions *

Provides various care coordination activities in collaboration with the client's 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 recipient's current needs/functioning. *
Communicates review decisions and prior authorizations to various professionals involved in the client's 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 client's 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 Molina's 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: *
Bachelor's Degree in a health care related field (Relevant experience will be considered in lieu of degree).

Required Experience: *
One year clinical experience or equivalent combination of education and experience.

Required Licensure/Certification:

Preferred Education:

Preferred Experience: *
Experience in social services, medical terminology. *
Experience in managed care environment; including knowledge or applicable state and federal regulations and standards. *
Knowledge of social support systems, resource and basic case management principles

Preferred Licensure/Certification:

To all current Molina employees if you are interested in applying for this position please apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.

Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

About this company
191 reviews
Navigating the murky waters of federal health care plans is no easy feat, but Molina Healthcare's mission is to help Medicaid and...