Care Manager, LTSS (BH Licensed)

Molina-Healthcare; Minooka (IL); On-site; USD 65,000 - 90,000; Full time

Job summary

Molina Healthcare Inc. seeks a qualified care management professional to coordinate LTSS services, collaborating with a multidisciplinary team to improve member outcomes and cost-effective care across the continuum.

Responsibilities include conducting comprehensive assessments, developing care plans with waiver services, monitoring progress, facilitating ICT meetings, and guiding members through enrollment steps. Travel of 25–40% may be required depending on state contracts.

Qualifications

• At least 2 years in health care with 1 year in care management, managed care or LTSS exposure.
• Experience with disabilities, chronic conditions, substance use disorders, and LTSS is preferred.

Responsibilities

• Completes comprehensive member assessments within regulated timelines and may include in-person home visits.
• Coordinates waiver enrollment/disenrollment and develops/carries out care plans with members and care teams.
• Monitors care plan effectiveness, documents interventions, and adjusts as needed.
• Promotes integrated services across behavioral health and LTSS, leveraging community resources.
• Assesses medical necessity, authorizes waiver services, and participates in ICT meetings.
• Educates and supports members using motivational interviewing and Molina clinical guideposts.
• Identifies barriers to care and helps members address psycho/social, financial, and medical obstacles.
• Travel to member locations may be required (25-40% depending on state/contractual needs).

Education

Clinical license (LCSW/LMSW/APSW/LPCC/LMFT/PhD)

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.
• 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.

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Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V