Care Manager, LTSS

Molina Healthcare, Inc.; Grove City (OH); On-site; USD 33,000 - 64,000; Full time

Job summary

Molina Healthcare is seeking a Care Coordinator for LTSS support. You will collaborate with a multidisciplinary team to coordinate care, assess medical necessity, and implement care plans that aim to meet member outcomes while controlling costs.

The role involves travel up to 40% and requires strong communication, organization, and knowledge of waiver services and community resources.

Qualifications

• At least 2 years of healthcare experience with LTSS emphasis.
• Licensure/certification only if state contract requires it.
• Bachelor's degree may be required in some states.

Responsibilities

• Complete member assessments within timelines; home visits as needed.
• Coordinate waiver enrollment/disenrollment processes.
• Develop and implement care plans with care team and members.
• Monitor and adjust care plans based on progress and outcomes.
• Promote integrated services across behavioral health and LTSS.
• Assess medical necessity and authorize waiver services.
• Evaluate benefits and funding sources; communicate options.
• Lead ICT meetings for approval/denial of services.
• Educate and motivate members using counseling techniques.
• Identify barriers and coordinate psychosocial, financial and medical support.
• Plan for travel 25-40% depending on state requirements.

Skills

Healthcare experience

Care management

Driver's license

MS Office

Communication skills

Time management

Problem solving

Team collaboration

Disabilities/ LTSS knowledge

Substance use disorder experience

Education

Bachelor's degree in healthcare

Clinical licensure/certification (if required)

Tools

Microsoft Office Suite

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.
• Assess 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: $24 - $46.81 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.