Care Manager, LTSS

Molina-Healthcare; Madison (WI); On-site; USD 52,000 - 76,000; Full time

Job summary

Molina Healthcare Inc is seeking a care management professional to support LTSS activities and coordinate member care across teams. The role focuses on comprehensive assessments, care planning, and ensuring progress toward desired outcomes.

Involves collaboration with caregivers, physicians, and other health professionals. Responsibilities include monitoring plans, ensuring medical necessity, and coordinating with ICT for service approvals.

Qualifications

• At least 2 years health care experience, including LTSS.
• Experience in care management or medical/behavioral health setting.
• Valid driver’s license and reliable transportation.
• Knowledge of community resources.
• Strong communication and problem-solving skills.
• Proficiency with Microsoft Office and online portals.
• In some states, experience with individuals with substance use disorders.

Responsibilities

• Completes comprehensive member assessments within regulated timelines, including in-person home visits.
• Facilitates waiver enrollment and disenrollment processes.
• Develops and implements care plans with members, caregivers, physicians and others.
• Monitors care plan effectiveness and documents interventions and goals.
• Promotes integration of behavioral health and LTSS services.
• Assesses medical necessity and authorizes waiver services.
• Facilitates interdisciplinary care team meetings for approvals/denials.
• Uses motivational interviewing to support member change; addresses barriers to care.
• Identifies incidents and develops prevention plans to safeguard member health.
• 25-40% travel may be required for member visits.

Skills

Care coordination

Home visits

Communication skills

Time management

Microsoft Office

Travel readiness

Independent work

Education

Bachelor’s degree (healthcare)

Clinical licensure/certification (where required)

Tools

EHR / Electronic health records

Job description

Remote with travel throughout Dane County, Wi for member visits

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)
• 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