Care Manager, LTSS - Bureau County

Molina Healthcare, Inc.; Ladd (IL); On-site; USD 52,000 - 90,000; Full time

Job summary

Molina Healthcare, Inc. seeks a Care Coordinator to support LTSS care management and coordination across the continuum for high-need members. You will collaborate with a multidisciplinary team to ensure quality and cost-effective care delivery.

Responsibilities include assessments, waiver processes, care plan development, and ongoing monitoring, with substantial local travel (25-40%) as required by state contracts.

Qualifications

• At least 2 years of health care experience with LTSS and care management.
• Clinical licensure/certification required only if state contract mandates it.
• Bachelor's degree in a health care field may be required by state/contract.
• Valid driver's license, reliable transportation, and auto insurance for travel.

Responsibilities

• Complete comprehensive member assessments within regulated timelines and home visits as needed.
• Facilitate waiver enrollment and disenrollment processes.
• Develop and implement care plans with members, caregivers, and providers.
• Monitor care plan effectiveness and adjust interventions as needed.
• Promote integration of LTSS and behavioral health services for continuity of care.
• Assess medical necessity and authorize waiver services.
• Coordinate ICT meetings for service approvals/denials.
• Travel locally 25-40% as required by state/contractual needs.

Skills

Healthcare experience

Care management

LTSS/Disabilities experience

Communication skills

Time management

Travel willingness

Driver's license

Community resources knowledge

Microsoft Office proficiency

Education

Health care bachelor degree

Clinical licensure/certification (if required by state)

Tools

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.
• 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