Care Manager, LTSS (BH Licensed)

Molina Healthcare; Ottawa (IL); On-site; USD 38,000 - 74,000; Full time

Job summary

Molina Healthcare is seeking a Care Manager to support LTSS-focused activities, collaborating with a multidisciplinary team to deliver integrated care for high-need members. The role involves conducting comprehensive assessments, coordinating waiver enrollment, developing and monitoring care plans, and navigating barriers to care while promoting behavioral health integration.

Travel 25–40% may be required; active licensure in a related field, strong communication, and organizational skills are

Qualifications

• 2+ years in health care with at least 1 year in care management or LTSS settings.
• Active and unrestricted license in state of practice as LCSW/LMSW/APSW/CHES/LPC/LPCC/LMFT/PhD/PsyD or equivalent.
• Bachelor's degree may be required in some states.
• Valid driver’s license, reliable transportation and auto insurance for travel.
• Ability to work independently and with diverse populations.

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 with members and care network to address needs and goals.
• Monitors care plan effectiveness, documents interventions and adjusts as needed.
• Promotes integration of LTSS and behavioral health services and community resources.
• Assesses medical necessity and authorizes waiver services; coordinates funding sources.
• Facilitates ICT meetings for approvals/denials and collaboration.
• Uses motivational interviewing to educate and motivate change during member contacts.
• Identifies barriers to care and assists with psycho/social, financial, and medical obstacles.
• Identifies critical incidents and develops prevention plans to safeguard member health.
• May provide consultation and resources to peers.

Skills

Care coordination

Community resources

Communication skills

Self-motivation

Time management

Problem-solving

Detail-oriented

Interdisciplinary collaboration

Education

LCSW/LMSW/APSW/CHES/LPC/LPCC/LMFT/PhD/PsyD license

Bachelor's degree in health care field

Tools

Microsoft Office

Electronic health records (EHR)

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.