Case Manager - Magnolia TX

Molina Healthcare; Long Beach (CA); Remote; USD 50,000 - 70,000; Full time

Job summary

Molina Healthcare seeks a Case Manager based in Texas, responsible for assessing and coordinating care for members in the Medicaid Star Plus program. This remote and field-based role involves collaborating with multidisciplinary teams to develop personalized care plans vital for member health. The candidate must possess strong communication skills and technical proficiency to thrive in a fast-paced environment.

Benefits

Mileage reimbursement

Competitive benefits package

Flexible work schedule

Qualifications

• 1 year of experience with individuals with disabilities or chronic conditions.
• Experience in case management or managed care settings.

Responsibilities

• Completes face-to-face assessments of members.
• Develops and implements care management plans.
• Conducts home visits as necessary for member care.

Skills

Case Management

Assessment

Interdisciplinary Coordination

Motivational Interviewing

Attention to Detail

Education

Licensed Vocational Nurse (LVN) or Bachelor's in Social Work

Accredited LPN Program

Tools

Microsoft Office

Electronic Health Records

Job description

JOB DESCRIPTION

For this position we are seeking a LVN or Licensed Social Worker who lives in TEXAS and must be licensed for the state of TEXAS

Case Manager will work in remote and field setting supporting our Medicaid Star Plus population. Case Manager will be required to physically go to member’s homes to complete Face to Face assessment. You will participate in interdisciplinary care team meetings for our members and ensure they have care plans based on their concerns/health needs. Members have required assessments every six months and can also require “trigger assessments” if they have hospitalizations. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position, and technical skills are needed with electronic database and Microsoft Office.

TRAVEL in the field to do member visits (Mileage is reimbursed) – covering zip codes Magnolia Gardens/Greater Greenspoint 77014, 77032, 77039, 77060, 77067, 77073, 77076, 77293

Home office with internet connectivity of high speed required

Schedule: Monday thru Friday 8:00AM to 5:00PM CST. - No weekends are Holidays

Job Summary

Molina Healthcare Services (HCS) works 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.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
• Performs ongoing monitoring of the 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 long-term services and supports, home and community to enhance the continuity of care for Molina members.
• Assesses for medical necessity and authorize all appropriate waiver services.
• Evaluates covered benefits and advise appropriately regarding funding source.
• Conducts face-to-face or home visits as required.
• Facilitates interdisciplinary care team meetings for approval or denial of servicesand 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 psycho/social, financial, and medical obstacles concerns.
• Identifies critical incidents and develops prevention plans to assure member’s health and welfare.
• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or master’s degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background

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 medical or behavioral health settings.

PREFERRED EXPERIENCE:

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.
• 1 year experience working with population who receive waiver services.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing

Valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation

STATE SPECIFIC REQUIREMENTS:

For the state of Wisconsin:

Bachelor’s degree or more advanced degree in the human services area and a minimum of one (1) year experience working with at least one of the Family Care target populations; or
Bachelor’s degree or more advanced degree in any area other than human services with a minimum of three (3) years’ experience working with at least one of the Family Care target populations.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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