Care Manager, Ltss

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

Job summary

Molina Healthcare is seeking a dedicated care management specialist to support LTSS coordination and cross-disciplinary care delivery for high-need members in Ohio. You will assess, develop and monitor care plans, coordinate waiver services and collaborate with physicians, caregivers and the care team to improve outcomes and cost-effectiveness.

Travel 25-40% and strong communication skills are essential as you navigate complex benefit configurations, medical necessity reviews and service

Qualifications

• 2+ years in health care with LTSS experience preferred.
• Clinical licensure/certification required only if state contract mandates it.
• Bachelor's degree may be required per state rules.
• Valid driver’s license and reliable transportation for travel.
• Strong communication and ability to work across diverse settings.

Responsibilities

• Complete comprehensive member assessments within regulated timelines.
• Facilitate waiver enrollment/disenrollment processes.
• Develop and implement care plans with care team and members.
• Monitor care plans and document interventions and outcomes.
• Promote integration of services across LTSS and behavioral health.
• Assess medical necessity and authorize waiver services.
• Facilitate ICT meetings for service approvals/denials.
• Identify barriers and coordinate psycho/social support.
• Travel 25-40% as required by state/contract.

Skills

Health care experience

Care management

Communication skills

Time-management

Problem-solving

Driver's license

Education

Bachelor's degree in health care related field

Tools

Microsoft Office

Online portals

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.