Care Manager, Ltss

Molina Healthcare; Edwardsville (IL); On-site; USD 35,000 - 68,000; Full time

Job summary

Molina Healthcare, Inc. seeks a care management professional to support LTSS care coordination. You will work with a multidisciplinary team to coordinate integrated member care, ensure timely assessments, and implement effective care plans.

Responsibilities include waiver management, documentation, and collaboration with providers, caregivers, and family members. Travel may be required to meet state contracts and member needs.

Qualifications

• 2+ years healthcare experience with LTSS or similar setting.
• 1+ year in care management or medical/behavioral health setting.
• Active/undisclosed licensure if state contract requires.
• Bachelor's degree may be required per state/contract.
• Valid driver's license and transportation for travel.
• Knowledge of community resources.

Responsibilities

• Complete comprehensive member assessments within regulated timelines, including home visits.
• Facilitate waiver enrollment and disenrollment processes.
• Develop and implement care plans with members and care team.
• Monitor and adjust care plans to achieve goals.
• Promote integrated services across LTSS and behavioral health.
• Assess medical necessity and authorize waiver services.
• Advise on benefits and funding sources.
• Lead ICT meetings for service approvals/denials.
• Use motivational interviewing and Molina guidelines.
• Identify barriers and coordinate supportive care.
• Identify incidents and plan prevention measures.
• Collaborate with licensed care managers as needed.
• Travel 25–40% as required by state/contractual rules.

Skills

Verbal communication

Written communication

Time management

Prioritization

Problem solving

Independence

Community resources knowledge

Diversity awareness

Microsoft Office proficiency

Education

Bachelor's degree in health care field

Clinical licensure/certification (if required)

Tools

Microsoft Office

Job description

JOB DESCRIPTION

Job Summary

Provides support for care management/care coordination long-term services and supports (LTSS)-specific activities. Collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care.
• Assesses for medical necessity and authorizes all appropriate waiver services.
• Evaluates covered benefits and advises appropriately regarding funding sources.
• Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns.
• Identifies critical incidents and develops prevention plans to assure member health and welfare.
• Collaborates with licensed care managers/leadership as needed or required.
• 25-40% estimated local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 2 years of health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.
• Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
• In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Demonstrated knowledge of community resources.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to operate proactively and demonstrate detail-oriented work.
• Ability to work independently, with minimal supervision and self-motivation.
• Ability to demonstrate responsiveness in all forms of communication and remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Problem-solving skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
• In some states, must have at least one year of experience working directly with individuals with substance use disorders.

Preferred Qualifications

• Certified Case Manager (CCM), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice.
• Experience working with populations that receive waiver services.

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

Pay Range: $25.2 - $49.15 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.