Case Manager, LTSS LCSW or LMSW Remote with Field Travel in New York

Molina Healthcare; Long Beach (CA); Remote; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager to join their team, focusing on providing integrated care for members with high-need potential. This role involves assessing and coordinating services for individuals eligible for Medicaid and Medicare, ensuring they receive the appropriate support and resources. The ideal candidate will have a strong background in case management and experience with long-term services and supports. If you are passionate about making a difference in the lives of others and thrive in a fast-paced environment, this opportunity is perfect for you.

Benefits

Competitive Benefits

Flexible Work Hours

Professional Development Opportunities

Qualifications

• At least 1 year of experience with disabilities and chronic conditions.
• Bachelor's or higher degree in relevant fields is required.

Responsibilities

• Complete assessments of members and develop case management plans.
• Facilitate care team meetings and promote service integration.

Skills

Organizational Skills

Time Management

Motivational Interviewing

Behavioral Health Knowledge

Long-term Services and Supports (LTSS)

Case Management

Education

Bachelor's/Master’s Degree in Social Sciences

Completion of an Accredited LVN or LPN Program

Tools

MS Excel

CCA

PEGA

Job description

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) collaborates with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high-need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

This position supports our Senior Whole Health business, which by Molina is a Managed Long-Term Care (MLTC) and Medicaid Advantage (MAP) plan. These plans streamline the delivery of long-term services to chronically ill or disabled individuals eligible for Medicaid and Medicare. We are seeking a Case Manager with an LMSW or LCSW licensure. Experience with Long-term Services and Supports (LTSS) is highly preferred. The candidate should possess strong organizational and time management skills, CCA and PEGA knowledge, and proficient MS Excel skills. The Case Manager must be capable of working in a high-volume environment to better serve our members. Bilingual Korean-speaking candidates are encouraged to apply.

Work hours: Monday - Friday, 8:30 am - 5:00 pm EST.

Remote position with field travel within the 5 boroughs.

KNOWLEDGE/SKILLS/ABILITIES

• Complete face-to-face comprehensive assessments of members within regulated timelines.
• Facilitate comprehensive waiver enrollment and disenrollment processes.
• Develop and implement a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician, and other healthcare professionals and support networks to address the member's needs and goals.
• Perform ongoing monitoring of the care plan to evaluate effectiveness, document interventions, and suggest changes as needed.
• Promote integration of services for members, including behavioral health care and long-term services and supports, to enhance continuity of care.
• Assess medical necessity and authorize appropriate waiver services.
• Evaluate covered benefits and advise on funding sources.
• Conduct face-to-face or home visits as required.
• Facilitate interdisciplinary care team meetings for service approval or denial and collaborate informally with ICT.
• Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate change during member contacts.
• Assess barriers to care, provide care coordination, and assist members in addressing psycho/social, financial, and medical obstacles.
• Identify critical incidents and develop prevention plans to ensure member health and welfare.
• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Completion of an accredited LVN or LPN program, or a bachelor's/master’s degree in social sciences, psychology, gerontology, public health, or social work, or an equivalent combination of education and experience.

REQUIRED EXPERIENCE:

• At least 1 year of experience working with persons with disabilities, chronic conditions, and Long Term Services & Supports.
• 1-3 years in case management, disease management, managed care, or behavioral health settings.

PREFERRED EXPERIENCE:

• 3-5 years in relevant fields.
• 1 year experience working with populations receiving waiver services.

PREFERRED LICENSE, CERTIFICATION, AND ASSOCIATION:

Active and unrestricted CCM, State Nursing license (LVN/LPN), or Clinical Social Worker license in good standing. Valid driver’s license with a good driving record and reliable transportation.

STATE SPECIFIC REQUIREMENTS:

For Wisconsin:

Bachelor’s or higher degree in human services with at least one year of experience working with Family Care populations, or a higher degree with three years of experience in the same.

Current Molina employees should apply through the intranet.

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