Specialist, Waiver Support

Molina Healthcare•Long Beach, CA

About The Position

Provides support for member waiver coordination activities. Contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the continuum, and overarching strategy to provide quality and cost-effective member care.

Requirements

At least 1 year of experience in an administrative support role in a health care setting, or equivalent combination of relevant education and experience.
Ability to manage multiple work tasks and prioritize.
Excellent problem-solving skills.
Strong verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs.

Nice To Haves

Certified Medical Assistant (CMA).
Long-term care and/or managed care experience.

Responsibilities

Provides non-clinical operational support for member waiver coordination processes.
Facilitates communication between waiver coordination and the state program support unit.
Receives initial state referrals for waiver services and works with long-term services and supports (LTSS) to schedule initial assessment.
Monitors status of initial member assessments, reassessments and transition assessments.
Interfaces with state agency that determines eligibility for LTSS, to process and obtain approval of waiver services.
Monitors transition process of nursing facility members in custodial beds to return to the community.
Initiates referrals for Medicare and waiver process if member is not already Medicare or waiver established.
Tracks referrals and case documents via designated state systems.
Tracks activities occurring within the transitional, assessment and authorization processes - using internal systems and designated state systems, and reports results to accordingly.
Ensures Medicaid and waiver eligibility has been requested and received from state partners before transition/services are initiated.
Maintains confidentiality and complies with Health Insurance Portability and Accountability Act (HIPAA).
Attends internal meetings and regularly scheduled calls as assigned.