Care Manager — LTSS & Waiver Services Lead

Jobtome; Elgin Township (IA); On-site; USD 35,000 - 68,000; Full time

Job summary

Molina Healthcare is hiring a care management professional to support LTSS coordination and member care across settings. You will collaborate with a multidisciplinary team to ensure progress toward outcomes and to help ensure high-quality, cost-effective care for members with complex needs.

The role includes conducting comprehensive member assessments, coordinating waiver enrollment, developing care plans with members and caregivers, and monitoring plan effectiveness.

Qualifications

• At least 2 years of health care experience, including LTSS and 1 year in care management.
• Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates.
• In some states, a bachelor's degree in a health care related field may be required.
• Valid and unrestricted driver's license, reliable transportation for job related travel requirements.

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, 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 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).

Skills

Care coordination

Communication skills

Time management

Problem-solving

Travel readiness

Education

Bachelor's degree in health care field

Tools

Microsoft Office

Online portals

Job description

Molina Healthcare is hiring a care management professional to support LTSS coordination and member care across settings. You will collaborate with a multidisciplinary team to ensure progress toward outcomes and to help ensure high-quality, cost-effective care for members with complex needs.

The role includes conducting comprehensive member assessments, coordinating waiver enrollment, developing care plans with members and caregivers, and monitoring plan effectiveness.