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Rep II Clinical Med D

CVS Health San Antonio, TX

Rep II Clinical Med D

CVS Health San Antonio, TX
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Company: Molina Healthcare
Location: San Antonio, TX
Career Level: Associate
Industries: Healthcare, Pharmaceutical, Biotech

Description



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
• Provide non-clinical operational support for Waiver coordination.
• Facilitate communication between Waiver coordinators and the state Program Support Unit.
• Responsible for receiving the initial State referrals for waiver services and working with the Long Term Services & Supports (LTSS) Coordinator to schedule the initial assessment.
• Monitor status for initial assessment, reassessment, and transition assessments for members.
• Interface with the State agency that determines eligibility and the LTSS Coordinator to process and obtain approval of Waiver services.
• Monitors transition process of Nursing Facility members in custodial beds to return to the community for 'Money Follows the Person' program.
• Initiates referral for Medicare and Waiver process if member is not already Medicare or waiver established.
• Tracks referrals and case documents via designated state systems.
• Track activities occurring within the transitional, assessment and authorization processes, using internal systems and designated state systems, and report results to coordinators, supervisors and the State agency.
• Ensure Medicaid and Waiver eligibility have been requested and received from state partners before transition or services are initiated.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Attend internal meetings and regularly scheduled calls as assigned.
• Other administrative functions as needed.

Qualifications

Job Qualifications

Required Education
HS Diploma or GED
Required Experience
• 1-3 years experience in an administrative support role in healthcare.
• Experience demonstrating ability to handle multiple work tasks, prioritize tasks, and excellent problem solving.
• Experience demonstrating strong communication skills.
Required License, Certification, Association
N/A
Preferred Education
Associate's Degree
Preferred Experience
• 3+ years experience in an administrative support role in healthcare, Medical Assistant preferred.
• 2 years Long Term Care experience preferred and/or Managed Care experience.
Preferred License, Certification, Association
N/A

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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