LTSS Care Manager & Care Coordination Specialist

Molina Healthcare, Inc.; Sycamore (SC); On-site; USD 35,000 - 68,000; Full time

Job summary

Molina Healthcare, Inc. is seeking a care management professional to support LTSS care coordination and member outcomes. You will collaborate with an interdisciplinary team to coordinate integrated care across the continuum for high-need members.

You will assess medical necessity, authorize waiver services, and help address psycho/social and financial barriers. Travel up to 40% may be required depending on state contracts.

Qualifications

• Requires 2+ years health care experience with LTSS and care management; includes required licensure if state mandates.
• Bachelor's degree in a health care related field may be required based on state/contractual requirements.
• Valid and unrestricted driver's license and reliable transportation for travel requirements.
• Proficiency with Microsoft Office and navigating online portals/databases.
• Experience with populations receiving waiver services is preferred in some states.

Responsibilities

• Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
• Facilitates waiver enrollment and disenrollment processes.
• Develops and implements care plans with members, caregivers, physicians, and care network.
• Monitors and documents progress, evaluates interventions and adjusts plans as needed.
• Promotes integration of services across behavioral health and LTSS; links to community resources.
• Assesses medical necessity and authorizes waiver services; reviews benefits and funding sources.
• Participates in ICT meetings for decisions on services; collaborates with care teams.
• Engages members using motivational interviewing and Molina clinical guidelines.
• Identifies barriers to care and coordinates resources to address psycho/social needs.
• Identifies incidents and develops prevention plans to safeguard member welfare.
• 25-40% local travel may be required depending on contract/state.

Skills

Care management

Disabilities and chronic conditions LT

Communication

Time management

Independent work

Problem-solving

Education

Bachelor's degree in health care related field

Clinical licensure/certification as required by state

CCM/LVN/LPN (preferred)

Tools

Microsoft Office

Job description

Molina Healthcare, Inc. is seeking a care management professional to support LTSS care coordination and member outcomes. You will collaborate with an interdisciplinary team to coordinate integrated care across the continuum for high-need members.

You will assess medical necessity, authorize waiver services, and help address psycho/social and financial barriers. Travel up to 40% may be required depending on state contracts.