Care Manager - Must live in UT

Molina Talent Acquisition; Midvale (UT); Vor Ort; USD 55.000 - 75.000; Vollzeit

Zusammenfassung

Molina Healthcare is seeking a Care Coordinator to review Utah Medicaid claims data, identify members who meet Restriction Program criteria, and support limited travel for in-state visits as needed.

The role manages an assigned caseload over a 12-month intervention period, coordinates care with providers, and ensures compliance with Utah Medicaid requirements while promoting quality outcomes and appropriate utilization of benefits.

Qualifikationen

• At least 2 years of health care experience in care management or equivalent.
• Clinical licensure and/or certification required only if state contract/regulation requires it.
• Valid driver's license, reliable transportation, and adequate auto insurance for job travel.
• Knowledge of community resources and ability to operate proactively.
• Strong verbal and written communication and time-management skills.
• Ability to work independently across diverse settings and populations.
• Proficiency with Microsoft Office and applicable software.
• Bachelor's degree in a health care related field may be required by contract.

Aufgaben

• Review Medicaid claims data to identify members meeting Restriction Program criteria.
• Manage a 12-month intervention caseload and provide care coordination.
• Coordinate with providers to implement lock-in assignments for provider/pharmacy.
• Conduct telephonic, in-person, or home visits as required.
• Monitor care plans, document interventions, and adjust as needed.
• Maintain ongoing member outreach and caseload management.
• Promote service integration across behavioral health, LTSS, and community resources.
• Facilitate interdisciplinary care team meetings and collaboration.
• Educate and motivate change using motivational interviewing and Molina guidelines.
• Identify barriers to care and assist members to address concerns.
• Collaborate with licensed care managers and leadership as required.
• Travel 25-40% based on state/contract requirements.

Kenntnisse

Care coordination

Communication

Time management

Problem solving

Travel readiness

Ausbildung

Bachelor's degree in health care

Tools

Microsoft Office

Jobbeschreibung

Job Summary

Responsible for reviewing Utah Medicaid claims data to identify members who meet Restriction Program criteria, including overutilization of emergency department services, multiple prescribers, multiple pharmacies, and potential overuse of controlled substances. Manages an assigned caseload of restricted members for a 12-month intervention period, providing care coordination and monitoring to support appropriate utilization of Medicaid benefits. Collaborates with providers to implement and maintain member lock-in assignments to a designated provider and pharmacy, promote quality outcomes, and ensure compliance with Utah Medicaid program requirements.

Essential Job Duties

• Completes assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments.
• Develops and implements care plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals.
• Conducts telephonic, face-to-face or home visits as required.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member caseload for regular outreach and management.
• Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
• Facilitates interdisciplinary care team (ICT) meetings 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, provides care coordination and assistance to member to address concerns.
• 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 experience in health care, preferably 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.
• 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(s) proficiency.
• In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).

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