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TAHMS Specialist (Transition Assistance)

Molina Healthcare Inc. - Irving, TX
Job via CareerBuilder
Job Number
111751557

Job Description



Transition Assistance and Home Modification Services (TAHMS) Specialist

Job SummaryAssist Care Coordinators efforts in transitioning members or prospective members to less restrictive and community based settings.

Essential Functions* Invoice or directly purchase supplies for members transitioning out of the nursing home, under the direction of the Care Coordinator.
* Perform home visits to ensure supplies and services have been delivered, meet quality standards, and member satisfaction, under the direction of the care coordinator,
* Enter authorizations into QNXT as required.
* Outreach calls within the first 30 days of waiver members with already established services transitioning into the health plan to ensure services are continuing and refer to service coordination when there is a request for additional services, if services are no longer in place, or if additional services are indicated.
* Review home modification needs and interface with contractors regarding the bidding process, follow up after home modifications are completed, notify the care coordinator of issues regarding the home modification process.
* Measure and track activities occurring within the transitional assistance process and report results to the supervisor. Community Based Organization / Provider Outreach
* Establish and Maintain relationships with Providers in assigned market.
* Follow up and notify providers of problems with supplies and services and communicate back to the care coordinator any issues and resolutions.
* Outreach calls and, if necessary, visits to the physician to obtain MD signature for the MN-LOC.
* Attend outreach meetings as assigned.
* Measure and track activities and submit monthly report to SPM. New Projects
* Participate in new initiatives for transitional activities.
* Assess ESRD members for Medicare enrollment, task to Star Plus Waiver coordinators for waiver assessments and upgrades, initiate dis-enrollment process if member does not meet Medicare or waiver qualifications.
* Measure and track results. State Plan / Department Specific Duties and Responsibilities* Perform as a backup to the Star Plus Waiver Coordinators' activities within the special programs department.

Knowledge/Skills/Abilities* Fluency of second language highly desired
* Ability to utilize sound judgment and independent thinking
* Ability to handle multiple tasks
* Local travel
* Excellent verbal and written communication skills
* Ability to abide by Molina's policies
* Ability to maintain attendance to support required quality and quantity of work
* 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:
High School Degree/GED.
Required Experience:
2 years managed care industry, preferably in CBA or directly with the Star +Plus Waiver Program.

Required Licensure/Certification:
Valid State driver license and reliable transportation.
Preferred Education:
Undergraduate degree

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.

Requirements:

Required Education:
High School Degree/GED.

Required Experience:
2 years managed care industry, preferably in CBA or directly with the Star +Plus Waiver Program.

Required Licensure/Certification:
Valid State driver license and reliable transportation.

Preferred Education:
Undergraduate degree
Education:
High School Degree/GED.
r +Plus Waiver Program.

Required Licensure/Certification:
Valid State driver license and reliable transportation.

Preferred Education:
Undergraduate degree
School Degree/GED.

Required Experience:
2 years managed care industry, preferably in CBA or directly with the Star +Plus Waiver Program.

Required Licensure/Certification:
Valid State driver license and reliable transportation.

Preferred Education:
Undergraduate degree

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