Care Manager, LTSS & Care Coordination

Molina Healthcare; Walnut (IL); On-site; USD 35,000 - 68,000; Full time

Job summary

Molina Healthcare seeks a care management professional to support LTSS initiatives. You will collaborate with a multidisciplinary team to coordinate member care, develop and monitor waiver service plans, and address psycho-social and medical needs across settings.

Role requires assessing medical necessity, facilitating ICT meetings, and guiding members toward desired outcomes while navigating benefits and funding options. Travel may be required.

Qualifications

• 2+ years healthcare experience with LTSS or related field.

Responsibilities

• Complete comprehensive member assessments within regulatory timelines, including in-person home visits as required.
• Develop and implement care plans with waiver service plans in collaboration with members, caregivers, physicians and other health professionals.
• Monitor care plans to evaluate effectiveness and adjust as needed.
• Promote integration of LTSS and behavioral health services with community resources.
• Assess medical necessity and authorize waiver services; review benefits and funding sources.
• Facilitate ICT meetings for service approval/denial and coordination.
• Educate and motivate members using motivational interviewing and Molina clinical guidelines.
• Identify barriers to care and coordinate support for psycho/social, financial, and medical needs.
• Identify critical incidents and develop prevention plans; liaise with licensed care managers.
• Travel up to 25-40% locally as required by state/contractual requirements.

Skills

Verbal communication

Written communication

Time management

Problem solving

Independence

Relationship building

Microsoft Office

Adaptability

Education

Bachelor’s degree in healthcare

Clinical licensure/certification as required by state

Tools

Online portals and databases

Mobile/wireless access to EHR

Job description

Molina Healthcare seeks a care management professional to support LTSS initiatives. You will collaborate with a multidisciplinary team to coordinate member care, develop and monitor waiver service plans, and address psycho-social and medical needs across settings.

Role requires assessing medical necessity, facilitating ICT meetings, and guiding members toward desired outcomes while navigating benefits and funding options. Travel may be required.