Care Manager, LTSS (BH Licensed)

Molina Healthcare; Marseilles (IL); On-site; USD 39,000 - 74,000; Full time

Job summary

Molina Healthcare is seeking a care management professional to support LTSS coordination and member care across settings. You will collaborate with an interdisciplinary team to ensure outcomes and cost-effective care for high-need members.

You will conduct comprehensive assessments, facilitate waiver enrollment, develop care plans with providers and family, monitor progress, and promote access to community resources. Travel may be required in some states.

Qualifications

• At least 2 years in health care with 1 year in care management/LTSS
• Active licensure as LCSW/LMSW/APSW/LPC/LPCC/LMFT/CCM or equivalent
• In some states, a healthcare-related bachelor's degree may be required
• Valid driver's license and reliable transportation for travel
• Ability to work independently with minimal supervision
• Strong communication and documentation skills
• Experience with substance use disorders preferred
• Proficiency with Microsoft Office
• Travel 25-40% may be required

Responsibilities

• Perform comprehensive member assessments within regulated timelines, including home visits as needed
• Facilitate waiver enrollment and disenrollment processes
• Develop and implement care plans with members, caregivers, physicians and others
• Monitor care plan effectiveness and document interventions
• Promote integration of LTSS and behavioral health services
• Assess medical necessity and authorize waiver services
• Evaluate benefits and funding sources
• Lead ICT meetings for service approval/denial
• Use motivational interviewing to educate and support
• Identify barriers to care and coordinate resources
• Identify critical incidents and develop prevention plans
• Travel 25-40% as required

Skills

Care coordination

Communication skills

Time management

Self-motivation

Travel readiness

Problem-solving

Interdisciplinary collaboration

Microsoft Office

Education

Social work licensure (LCSW/LMSW/APSW/CHES/LPC/LPCC/LMFT/PhD/PsyD)

Healthcare degree (bachelor) where required

Tools

EHR proficiency

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.
• Assess 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.
• May provide consultation, resources and recommendations to peers as needed.
• 25-40% estimated local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 2 years of experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
• Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT, Doctor of Psychology (PhD or PsyD) or equivalency based on state contract, regulation, or state board licensing mandate. 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.
• Ability to operate proactively and demonstrate detail-oriented work.
• Demonstrated knowledge of community resources.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• Responsiveness in all forms of communication, and ability to 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(s) proficiency.
• 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

Pay Range: $27.73 - $54.06 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.