Care Manager, LTSS

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

Job summary

Molina Healthcare is seeking a Care Manager to support LTSS coordination, partnering with a multidisciplinary team to deliver integrated member care and drive outcomes while contributing to cost-effective strategy.

Responsibilities include comprehensive assessments, waiver services, care plan development and monitoring, and coordination with members, caregivers, physicians, and providers. Travel 25-40% may be required based on state contracts.

Qualifications

• 2+ years health care experience with LTSS or disability/chronic conditions.
• Licensure/certification only if required by state contract or regulation.
• Bachelor's degree may be required in some states.
• Valid driver's license and reliable transportation for state travel.

Responsibilities

• Completes member assessments within timelines, including in-person visits where required.
• Facilitates waiver enrollment/disenrollment processes.
• Develops and implements care plans with members, caregivers and providers.
• Monitors care plan effectiveness and documents interventions.
• Promotes integration of LTSS and behavioral health with community resources.
• Assesses medical necessity and authorizes waiver services.
• Evaluates benefits and advises on funding sources.
• Facilitates ICT meetings for approvals and collaboration.
• Uses motivational interviewing to educate and motivate change.
• Addresses psycho/social, financial, and medical barriers to care.
• Develops prevention plans for critical incidents; supports professionals as needed.
• Collaborates with licensed care managers and leadership.
• 25-40% local travel may be required.

Skills

Communication skills

Time management

Travel flexibility

Motivational interviewing

Interdisciplinary collaboration

Documentation & record keeping

Education

Bachelor's degree in health care field

Tools

Microsoft Office

Online portals / databases

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