LTSS Care Manager: Care Coordination & Outcomes

Molina Healthcare, Inc.; Rockford (IL); On-site; USD 65,000 - 80,000; Full time

Job summary

Molina Healthcare in Rockford, IL is seeking a Care Manager to provide support for LTSS coordination, collaborating with a multidisciplinary team to ensure high-need members receive integrated care.

You will complete assessments, develop and monitor care plans, coordinate waiver services, and navigate benefits and funding. Travel up to 40% may be required depending on state contracts.

Qualifications

• At least 2 years of health care experience.
• 1 year of care management or equivalent in medical/behavioral health.
• Licensure/certification required only if state contract mandates, active and unrestricted if licensed.
• Bachelor's degree in health care related field may be required in some states.
• Valid driver's license, reliable transportation, and adequate auto insurance for job travel.
• Demonstrated knowledge of community resources.
• Ability to work with diverse populations and adjust style as needed.
• Strong verbal and written communication skills.
• Microsoft Office proficiency and ability to navigate online portals.
• In some states, at least one year of experience with individuals with substance use disorders.

Responsibilities

• Complete comprehensive member assessments within regulated timelines, including in-person home visits.
• Facilitate comprehensive waiver enrollment and disenrollment processes.
• Develop and implement care plans with members, caregivers, physicians and other health care professionals.
• Monitor care plan effectiveness, document interventions and goals achieved, and suggest changes.
• Promote integration of LTSS and behavioral health services and home/community resources.
• Assess medical necessity and authorize waiver services.
• Evaluate covered benefits and advise on funding sources.
• Facilitate interdisciplinary care team meetings for approval/denial of services.
• Travel 25-40% locally as required by state/contract.

Skills

Healthcare experience

LTSS experience

Care management experience

Medical/behavioral health setting

Strong communication

Microsoft Office proficiency

Driver's license

Knowledge of community resources

Detail-oriented

Independent work

Team collaboration

Substance use disorders experience

Education

Bachelor's degree in health care or related field

Job description

JOB DESCRIPTION Job Summary

Provides support for care management/care coordination long-term services and supports (LTSS)-specific activities. Collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals.
• Performs ongoing monitoring of 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 (LTSS) and home and community resources to enhance continuity of care.
• Assesses for medical necessity and authorizes all appropriate waiver services.
• Evaluates covered benefits and advises appropriately regarding funding sources.
• Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services 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 and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns.
• Identifies critical incidents and develops prevention plans to assure member health and welfare.
• 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 of health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience 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. If licensed, license must be active and unrestricted in state of practice.
• In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).
• 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 work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to operate proactively and demonstrate detail-oriented work.
• 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.
• Time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Problem-solving skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
• In some states, must have at least one year of experience working directly with individuals with substance use disorders.


Preferred Qualifications

• Certified Case Manager (CCM), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice.
• Experience working with populations that receive waiver services.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

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