Molina Healthcare is hiring for a School Health Services Member Liaison. Candidates must live in Clark County. There will be 50% +/- local travel within the area. 
Bilingual Spanish desired, not required.

Job Summary
The School Health Services Member Liaison will perform outreach activities with each school district in Nevada at least quarterly.  This role will also be handling Pediatric Care Coordination including, but not limited to- support families with any care coordination needs (establishing new patient care, transportation needs, home health/DME needs, nutrition supports, etc.) they may have for their pediatric member. 

Local travel will be up to 50% +/- with 1-2 days/week in the field. This role will support the Medicaid LOB in a Care Management Department working alongside other Care Management associates.

Knowledge/Skills/Abilities

• Manage Enrollment and Disenrollment Processes. Become an authority on the enrollment and disenrollment processes as mandated by the AHCCCS contract and technical requirements. Understanding the member’s experience throughout the organization is essential for ensuring a seamless process for members.
• Analyze disenrollment data to pinpoint trends. Work collaboratively across departments to formulate and implement strategies that effectively address these trends, aiming to decrease overall disenrollment rates.
• Accountable for Onboarding and Rapid Disenrollment. Review the onboarding process and instances of rapid disenrollment to identify potential areas for intervention. Enhancing these processes will improve member retention and satisfaction.
• Analyze and engage with members on The Open Enrollment Potential Transition Listing files. Understanding why members may be leaving, the plan allows for the development of targeted interventions aimed at reducing disenrollment. Inter-departmental collaboration is crucial for this initiative.
• Collaborate closely with MHI on 90-day redetermination strategies to enhance transparency in the health plan. This partnership will help promptly identify and address redetermination issues.
• Assess the MHI process with HEA Plus to identify opportunities for improving redetermination. Streamlining these processes will foster a more efficient and member-friendly experience, with results being reported into the governance process.
• Integrate grievance trends, reasons for member calls from the call center, and input from other areas into the disenrollment analysis. This comprehensive approach will aid in understanding and addressing member concerns.
• Develop a governance process that involves all departments. This process should ensure that disenrollment rates, activities to reduce disenrollment, and the status of efforts and continuous improvement initiatives are regularly reported and reviewed.
• Engage Member Concierge services to identify broader themes of abrasion affecting a larger group of members.
• Analyze the Key performance indicators on key member retention standard metrics in planning all retention activities, including: NPS, Rapid disenrollment, Provider disenrollment.
• Create and formulate initiatives to support auto-assignment of membership to the health plan is Quality/STARS or PCP driven.
• Investigates and resolves access and cultural sensitivity issues identified by HMO staff, State staff, providers, advocate organizations, subcontractors, and enrollees.
• Provides ongoing training and educational materials to HMO and relevant subcontractor employees and providers as needed.
• Collaborates with the Care Management department to help resolve member issues/concerns, ensure that trends are identified, and solutions are outlined.
• Analyzes internal HMO system functions that affect enrollee access to medical care and quality of care. Offers information, guidance, and assistance over the phone or in person to members with disabilities or BC+ who call for help related to their HMO participation.
• Acts as a resource for Molina staff and members regarding community agencies, services, and referrals for special needs, Medicaid in general, or other related needs.
• Participates in the Statewide Advocacy Program for Managed Care, working with the State External Advocate, Enrollment Specialist, and Ombudsmen on issues of access to medical care, quality of care, enrollment, and disenrollment.

REQUIRED EDUCATION:

• Experience in this and/or related field or Bachelor's Degree in Social Work, Human Services.

PREFERRED EDUCATION:

• Graduate Degree in Social Work, Human Services or related field.

REQUIRED EXPERIENCE:

• 3-5 years experience working with the Medicaid population, preferably in an HMO or MCO setting, with experience in working with disabled, underserved and/or disadvantaged populations.

PREFERRED EXPERIENCE:

• 5+ years working with the Medicaid population, preferably in an HMO or MCO setting, with experience in working with disabled, underserved and/or disadvantaged populations.
• Bilingual Spanish desired, not required.
• Community Health Worker Certification 
• School based experience 

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $52,426 - $102,231 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.