Care Manager, Ltss

Molina Healthcare; Milwaukee (WI); Remote; USD 68,770,000 - 134,129,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare seeks a Care Manager for LTSS coordination, remote with travel in Chippewa and Eau Claire Counties, WI. You will assess members, develop care plans, and coordinate services with a multidisciplinary team to improve outcomes.

You will travel 25-40% locally, conduct home visits, review waivers, and monitor plans. Strong communication, independence, and knowledge of community resources are essential.

Qualifications

• At least 2 years of health care experience, including 1 year working with persons with disabilities/chronic conditions LTSS and 1 year in care management.
• Clinical licensure and/or certification required only if mandated by state contract or licensing rules.
• In some states, a bachelor's degree in a health care related field may be required.
• Valid driver's license with reliable transportation for job-related travel.
• Demonstrated knowledge of community resources.
• Ability to work across settings with diverse populations.
• Ability to work independently with minimal supervision.
• Strong verbal and written communication skills.
• MS Office proficiency and ability to navigate online portals/databases.

Responsibilities

• Complete comprehensive member assessments within regulated timelines, including in-person home visits as required.
• Facilitate comprehensive waiver enrollment and disenrollment processes.
• Develop and implement care plans with members, caregivers, physicians, and other health care professionals.
• Monitor care plan effectiveness and document interventions and goal achievement.
• Promote integration of behavioral health and LTSS services for continuity of care.
• Assess medical necessity and authorize appropriate waiver services.
• Evaluate covered benefits and advise on funding sources.
• Facilitate ICT meetings for approvals or denials.
• Use motivational interviewing and Molina guides to educate and motivate change.
• Identify barriers to care and provide coordination to address psycho/social, financial, and medical obstacles.
• Identify critical incidents and develop prevention plans.
• Collaborate with licensed care managers as needed.
• Travel 25-40% locally as required by state/contractual requirements.

Skills

Verbal communication

Written communication

Time management

Problem solving

Independence

Education

Bachelor's degree in health care field

Tools

Microsoft Office

Online portals/databases

Job description

Remote with travel throughout Chippewa and Eau Claire Counties, 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

• 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 based on posting based on geographic location, work experience, education and/or skill level.