LTSS Care Manager — High-Impact Care Coordination

Molina Healthcare, Inc.; Newark (NJ); On-site; USD 33,000 - 64,000; Full time

Job summary

Molina Healthcare, Inc. seeks a care management professional to support LTSS coordination and integrated member care. You will collaborate with multidisciplinary teams to ensure outcomes and cost-effective services across care settings.

Responsibilities include comprehensive assessments, waiver enrollment/disenrollment, care plan development, and monitoring. Travel may be required; licensure/certification rules vary by state.

Qualifications

• At least 2 years of health care experience, including LTSS and care management.
• Licensure or certification required only if mandated by state contract or regulation.
• Bachelor's degree may be required in some states.
• Valid and unrestricted driver's license with reliable transportation for job-related travel.
• Knowledge of community resources.
• Ability to work independently and manage multiple projects.
• Strong communication and organizational skills.
• In some states, 1 year of experience with individuals with substance use disorders.

Responsibilities

• Completes comprehensive member assessments within regulated timelines, including in-person home visits when required.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• Develops and implements care plans, including a waiver service plan with members, caregivers, physicians and others.
• Monitors care plan effectiveness, documents interventions and goal achievement, and suggests changes.
• Promotes integration of services across LTSS, behavioral health, and community resources to improve continuity of care.
• Assesses medical necessity and authorizes all appropriate waiver services.
• Evaluates benefits and advises on funding sources.
• Facilitates ICT meetings for approval/denial and cross-team collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate and motivate change.
• Identifies barriers to care and provides coordination to address psycho/social, financial, and medical obstacles.
• Identifies critical incidents and develops prevention plans to safeguard member welfare.
• Collaborates with licensed care managers/leadership as needed.
• Travel 25-40% locally according to state/contractual requirements.

Job description

Molina Healthcare, Inc. seeks a care management professional to support LTSS coordination and integrated member care. You will collaborate with multidisciplinary teams to ensure outcomes and cost-effective services across care settings.

Responsibilities include comprehensive assessments, waiver enrollment/disenrollment, care plan development, and monitoring. Travel may be required; licensure/certification rules vary by state.