Care Manager, LTSS (BH Licensed) - Bureau, IL

Molina Talent Acquisition; Illinois; Sur place; USD 60 000 - 85 000; Plein temps

Résumé du poste

Molina Healthcare is seeking a qualified Care Manager to coordinate long-term services and supports for high-need members in Illinois. You will collaborate with multidisciplinary teams, assess medical necessity, and develop comprehensive care plans to improve outcomes while balancing cost-effective care.

Responsibilities include conducting home visits when required, managing waiver processes, and facilitating ICT meetings.

Qualifications

• At least 2 years in health care with care management and LTSS.
• Licensure as LCSW/LMSW/APSW/CHES/LPC/LPCC/LMFT or doctoral equivalency.
• Valid driver’s license and auto insurance for travel.
• Knowledge of community resources.
• Ability to work independently and with diverse populations.
• Proactive, detail-oriented, and strong communication skills.
• Experience with substance use disorders in some states may be required.

Responsabilités

• Complete comprehensive member assessments within timelines, including in-person home visits.
• Facilitate waiver enrollment and disenrollment processes.
• Develop and implement care plans with members, caregivers, physicians, and others.
• Monitor care plans and document outcomes; adjust as needed.
• 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 decisions.
• Use motivational interviewing to support and motivate change.
• Identify barriers to care and coordinate psycho/social, financial, and medical assistance.
• Identify critical incidents and develop prevention plans.
• Provide consultation to peers as needed.
• Travel 25–40% depending on state contracts.

Connaissances

Care management

LTSS experience

Behavioral health

Motivational interviewing

Communication skills

Time management

ICT meetings

Microsoft Office

Driver's license

Formation

LCSW/LMSW/LPC/LMFT license

APSW or CHES

PhD/PsyD or equivalent

Outils

None

Description du poste

JOB DESCRIPTION Job Summary

Provides support for care management/care coordination long-term services and supports specific activities and 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 experience in health care, including at least 1 year of 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.
• 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 operate proactively and demonstrate detail-oriented work.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• 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.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving, and critical-thinking 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).
• Experience working with populations that receive waiver services.

#PJHS

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