Care Manager - Must live in UT

Molina Healthcare Inc; Midvale (UT); On-site; USD 60,000 - 78,000; Full time

Job summary

Molina Healthcare Inc. in Utah is hiring a Care Coordination Specialist to review Medicaid claims and identify members meeting Restriction Program criteria, including overutilization of emergency services, multiple prescribers, and multiple pharmacies.

You will manage a 12-month intervention caseload, provide care coordination and monitoring, collaborate with providers to implement lock-in assignments to a designated provider and pharmacy, and travel locally 25-40% as required.

Qualifications

• At least 2 years of health care experience, preferably care management or related setting.
• Licensure/certification required only if mandated by state contract or licensing mandates.
• Valid and unrestricted driver's license and reliable transportation for local travel.
• Ability to work with diverse populations and across settings.
• Proactive, detail-oriented, and able to manage multiple projects.

Responsibilities

• Review Utah Medicaid claims data to identify members meeting Restriction Program criteria.
• Manage a 12-month intervention caseload with care coordination and monitoring.
• Collaborate with providers to implement lock-in assignments to a designated provider and pharmacy.
• Perform assessments and develop care plans with the care team.
• Conduct telephonic or in-person visits and track progress.

Skills

Communication skills

Time management

Problem solving

Detail oriented

MS Office proficiency

Education

Bachelor\'s degree in health care related field

Clinical licensure/certification (as required by state contract)

Tools

MS Office

Job description

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