Top 225 Member advocate Jobs in Charleston, Sc

Health Plan Provider Relations Representative
Molina Healthcare —Charleston, SC
- $18.85 - $38.69 an hour
- Full-time
- Medical office experience
- Mid-level
- Training & development
- Health insurance
12d
Part Time Community Navigator (Charleston, SC)
Ounce of Care —Charleston, SC
- $26 - $32 an hour
- Part-time
- Outdoor work
- Entry level
Quick Apply
13d
Graduation Candidate Advocate
Acceleration Academies —North Charleston, SC
- From $18 an hour
- Full-time
- School experience
- Classroom
- Spanish
- Disability insurance
- Health insurance
Quick Apply
Social Worker
Charleston County School District —Charleston, SC
- $51,771 - $100,608 a year
- Online Application
- Background check
- School experience
- Master of Social Work
- Health insurance
- Dental insurance
Quick Apply
Brand Ambassador
Sandpiper Productions —Charleston, SC
- $62,400 - $72,800 a year
- Weekends as needed
- Bar
- 21 years or older
- Reliable transportation
- Flexible schedule
Quick Apply
Retail Sales Associate, Charleston - Part Time
Bluemercury —Charleston, SC
- $16.50 - $25.22 an hour
- Part-time
- Inventory management
- Mid-level
- High school diploma or GED
- Store discount
- Health insurance
Clinical Research Coordinator, Registered Nurse
Advanced Urology Institute LLC —North Charleston, SC
- Full-time
- Nursing
- Blood sampling
- RN License
Quick Apply
Emergency Room Registered Nurse Weekends
HCA Healthcare Long Point Emergency Room —Mount Pleasant, SC
- Weekends as needed
- Mid-level
- 1 year
- Employee stock purchase plan
- Disability insurance
Quick Apply
Medical Surgical Registered Nurse Weekend Nights
HCA Healthcare Trident Hospital —Charleston, SC
- Weekends as needed
- Mid-level
- Critical & Intensive Care
- Medical-Surgical
- Employee stock purchase plan
- Disability insurance
Quick Apply
Emergency Room Registered Nurse
HCA Healthcare Long Point Emergency Room —Mount Pleasant, SC
- Full-time
- Mid-level
- 1 year
- Employee stock purchase plan
- Disability insurance
Quick Apply
11d
Registered Nurse (RN) - Buxton Surgical Pavilion- Roper Hospital
Roper St. Francis Healthcare —Charleston, SC
- Nursing
- Surgery
- RN License
- Health savings account
- Disability insurance
Registered Nurse (RN) — Nephrology — Roper Hospital
Roper St. Francis Healthcare —Charleston, SC
- 12 hour shift
- Nursing
- RN License
- Hospital
- Health savings account
- Disability insurance
Oncology Med Surg Registered Nurse
HCA Healthcare Trident Hospital —Charleston, SC
- Full-time
- Surgery
- Mid-level
- Medical-Surgical
- Employee stock purchase plan
- Disability insurance
Quick Apply
Registered Nurse (RN) – Dialysis – Roper Hospital
Roper St. Francis Healthcare —Charleston, SC
- 12 hour shift
- Nursing
- RN License
- Hospital
- Health savings account
- Disability insurance
Registered Nurse (RN) - Intermediate Care Unit - Roper Hospital
Roper St. Francis Healthcare —Charleston, SC
- Rotating weekends
- Nursing
- RN License
- Bachelor of Science
- Health savings account
- Disability insurance
Registered Nurse (RN) — Intermediate Care Unit — Berkeley Hospital
Roper St. Francis Healthcare —Summerville, SC
- Nursing
- RN License
- BLS Certification
- Health savings account
- Disability insurance
Registered Nurse (RN) - Intermediate Care (IMCU) - Berkeley Hospital - Weekend Only
Roper St. Francis Healthcare —Summerville, SC
- Full-time
- Nursing
- RN License
- Bachelor of Science
- Health savings account
- Disability insurance
James Island Emergency Room RN
HCA Healthcare James Island ER —Charleston, SC
- Full-time
- Mid-level
- 1 year
- Employee stock purchase plan
- Disability insurance
Quick Apply
New Graduate RN Residency
HCA Healthcare Summerville Hospital —Summerville, SC
- Full-time
- No experience needed
- Travel
- 1 year
- Employee stock purchase plan
- Disability insurance
Quick Apply
Registered Nurse (RN) — Oncology — Roper Hospital — Weekend Only
Roper St. Francis Healthcare —Charleston, SC
- Nursing
- RN License
- Hospital
- Health savings account
- Disability insurance

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Health Plan Provider Relations Representative

Molina Healthcare -
Charleston, SC

Apply Now

Job Details

Full-time
$18.85 - $38.69 an hour
12 days ago

Benefits

Health insurance

Qualifications

Customer communication
Managed care
Managed care organization experience
Medical office experience
Schedule management
Health insurance knowledge
Productivity software
Cross-functional collaboration
Cross-functional communication

Full Job Description

_*Remote and must live in South Carolina*_

JOB DESCRIPTION

Job Summary

Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures.

Essential Job Duties

Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers.
Serves as the primary point of contact between Molina health plan and the non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers.
Collaborates directly with the plan’s external providers to educate, advocate and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption.
Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.
Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship.
Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters.
Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include: issues related to utilization management, pharmacy, quality of care, and correct coding).
Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; may also deliver training and presentations to larger groups, such as leaders and management of provider offices, including large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs).
Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.).
May provide training and support to new and existing provider relations team members as appropriate.
Role requires 60%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area).

Required Qualifications

At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience.
General understanding of the health care delivery system, including government-sponsored health plans.
Organizational skills and attention to detail.
Ability to manage multiple tasks and deadlines effectively.
Interpersonal skills, including ability to interface with providers and medical office staff.
Ability to work in a cross-functional highly matrixed organization.
Effective verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc.
Experience delivering training and facilitating educational presentations.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $18.85 - $38.69 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

member advocate jobs in charleston, sc

Health Plan Provider Relations Representative

Part Time Community Navigator (Charleston, SC)

Graduation Candidate Advocate

Social Worker

Brand Ambassador

Retail Sales Associate, Charleston - Part Time

Clinical Research Coordinator, Registered Nurse

Emergency Room Registered Nurse Weekends

Medical Surgical Registered Nurse Weekend Nights

Emergency Room Registered Nurse

Registered Nurse (RN) - Buxton Surgical Pavilion- Roper Hospital

Registered Nurse (RN) — Nephrology — Roper Hospital

Oncology Med Surg Registered Nurse

Registered Nurse (RN) – Dialysis – Roper Hospital

Registered Nurse (RN) - Intermediate Care Unit - Roper Hospital

Registered Nurse (RN) — Intermediate Care Unit — Berkeley Hospital

Registered Nurse (RN) - Intermediate Care (IMCU) - Berkeley Hospital - Weekend Only

James Island Emergency Room RN

New Graduate RN Residency

Registered Nurse (RN) — Oncology — Roper Hospital — Weekend Only

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