Social Health Member Navigator - Temporary

Lets do great things together!

About Moda
Founded in Oregon in 1955 Moda is proud to be a company of real people committed to quality. Today like then were focused on building a better future for healthcare. That starts by offering outstanding coverage to our members compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Lets be better together.

Please fill out an application on our company page linked below to be considered for this position.

Dental Vision &Pharmacy

Required Skills Experience & Education:

• Bachelors degree or equivalent.
• 2 years of experience in healthcare public health communitybased organizations including work in or with rural or underserved communities.
• Experience in a medical office social work case management and/or utilization management preferred.
• Traditional Health Worker certification or intent to complete within 6 months of hire date.
• Proven history of strong attention to detail and thoroughness.
• Detailed understanding of HRSN and Medicaid complexities.
• Proven history of strong organizational skills and ability to meet established deadlines.
• Ability to work well under pressure in a complex and rapidly changing environment.
• Ability to communicate customers and members interests and needs to internal project teammates to improve work flows and processes.
• Strong presentation skills.
• Type a minimum of 60 wpm neton a computer keyboard.
• Strong statistical analytical and problemsolving skills.
• Excellent oral written and interpersonal communication skills and the ability to interact professionally patiently and courteously with customers over the phone and in person.
• Ability to maintain confidentiality and present a positive and professional image in the communities we serve.
• Demonstrates proficiency in desktop application software including email word processing spreadsheets and creating presentations.

Primary Functions:

• Conducts eligibility screenings for HRSN requests which includes outreach to members providers or other entities.
• Determines the most effective utilization of HRSN funds by reviewing requests against state established criteria.
• Reviews requests from outside entities triages member needs and directs to care coordination.
• Manages HRSN requests to ensure members are offered and receive medically necessary services.
• Ensures documentation in the HRSN needs assessment is thorough for all memberrelated service requests and meets Oregon Health Authority requirements.
• Provides education to members and providers regarding HealthRelated Social Needs including how to request criteria for coverage availability of resources and case management services.
• Consult with the HRSN Manager or RN on complex cases.
• Utilizes multiple business accounts for ordering and tracking items approved through HRSN benefits.
• Remains current on all Oregon Health Authority guidance regarding healthrelated social needs benefits
• Utilizes the Moda Health core systems (CCA Facets benefit tracker etc) for eligibility and benefit verification documentation of contact with providers and members.
• Provides data entry for HRSN reporting
• Conducts post authorization referrals and assignments to HRSN service providers.
• Provides additional outreach to members as needed to offer support services or connection to other resources.
• Completes documentation to support compliance deliverables related to reporting throughout the year.
• Send proper correspondence to providers members and other departments to identify support persons and notify EOCCO designated care coordination staff.
• Ensure adherence to the Health Insurance Portability and Accountability Act (HIPPA) and other regulatory guidelines including privacy and security.
• Must maintain 98 quality audit scores regarding care planning documentation.
• Identifies problems and researches alternative solutions.
• Works with other team members to meet member needs related to care coordination.
• Completes other duties and special projects as assigned
• Maintain accurate patient note entry in Moda systems to improve communication amongst internal and external partners.

• Hybrid office environment 3 days per week or more as needed with extensive close PC and keyboard work consistent sitting must be able to navigate multiple screens. Work in excess of 40 hours per week including evenings and occasional weekends to meet business need.
• Multiple internal departments including but not limited to: Healthcare Services Case Management and Claims. Externally with Members HRSN service providerscommunitybased organization and other health systems across service area.

Together we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race religion color age sex sexual orientation national origin marital status disability veteran status or any other status protected by law. This is applicable to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absences compensation and training.

For more information regarding accommodations please direct your questions to Kristy Nehler & Danielle Baker via email.