Care Manager, Ltss

Jobtome; Reynoldsburg (OH); On-site; USD 33,000 - 64,000; Full time

Job summary

Molina Healthcare is seeking a Care Manager to support LTSS care coordination and member outcomes in Reynoldsburg, OH. You will collaborate with a multidisciplinary team to coordinate integrated care across the continuum for high-need members, performing home visits and developing care plans with members and caregivers.

Responsibilities include assessing medical necessity, authorizing waiver services, and ensuring quality and cost-effective care.

Qualifications

• At least 2 years health care experience, including LTSS.
• 1 year of care management or equivalent experience in medical/behavioral health setting.
• Valid and unrestricted driver's license for job-related travel.
• Active licensure/certification only if required by state contract or regulation.
• Experience with community resources.

Responsibilities

• 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 with members, caregivers, physicians and/or other health professionals.
• Monitors care plan effectiveness, documents interventions and goals, and suggests changes.
• Promotes integration of services including behavioral health and LTSS to improve continuity of care.
• Assesses medical necessity and authorizes waiver services.
• Evaluates benefits and funding sources.
• Facilitates ICT meetings for approval/denial of services.
• Uses motivational interviewing to educate, support and motivate change.
• Assesses barriers to care and provides care coordination for psycho/social, financial, and medical obstacles.
• Identifies critical incidents and develops prevention plans.
• Collaborates with licensed care managers/leadership as needed.
• Travelling 25-40% depending on state/contractual requirements.

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: $24 - $46.81 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.