Care Manager - Must live in UT

Molina Healthcare; Midvale (UT); Híbrido; USD 33.000 - 64.000; Jornada completa

Descripción de la vacante

Molina Healthcare is seeking a Care Coordination Specialist to review Utah Medicaid claims data and identify members meeting Restriction Program criteria. You will manage a 12-month intervention caseload, coordinate with providers, and promote appropriate utilization of benefits.

Responsibilities include care plan development, telephonic and home visits, and collaboration with interdisciplinary teams. Travel 25-40% may be required; strong communication and problem-solving skills are essential.

Formación

• 2+ years in health care or care management.
• Clinical licensure/certification required ONLY if required by state contract, regulation, or licensing mandates.
• Valid driver’s license, reliable transportation, and auto insurance for job-related travel.
• Knowledge of community resources.
• Strong communication and time-management skills.

Responsabilidades

• Reviews Medicaid claims data to identify members who meet care coordination criteria.
• Develops and implements care plans with member, caregivers, and health professionals.
• Conducts telephonic, in-person, or home visits as required.
• Monitors care plans and documents interventions and goal achievement.
• Manages an assigned caseload for a 12-month intervention period.
• Coordinates with providers to implement and maintain lock-in to a provider and pharmacy.
• Facilitates interdisciplinary care team meetings and collaboration.
• Educates and motivates members during contacts using motivational interviewing.
• Assesses barriers to care and provides assistance to address concerns.
• Collaborates with care managers and leadership as needed.
• Travel 25-40% based on state/contract requirements.

Conocimientos

Care coordination

Communication skills

Time management

Problem solving

Independent work

Travel readiness

Educación

Bachelor’s degree in health care

Herramientas

Microsoft Office

Descripción del empleo

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

Pay Range: $24 - $46.81 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.