LTSS Care Navigator

Molina Healthcare; Tiskilwa (IL); On-site; USD 34,000 - 68,000; Full time

Job summary

Molina Healthcare in Illinois is seeking a care management professional to support LTSS coordination and member care across settings. You will collaborate with the multidisciplinary team to develop and monitor care plans, including waiver services, with an emphasis on improving outcomes and controlling costs.

The role involves assessing medical necessity, coordinating with providers, and navigating systems and resources while maintaining effective communication with members and caregivers.

Qualifications

• 2+ years health care experience with LTSS preferred.
• Active licensure if required by state contract or regulations.
• Valid and unrestricted driver’s license for job-related travel.
• Experience working with diverse populations.
• Experience with substance use disorders preferred in some states.

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 adjust as needed.
• Promote integration of LTSS and behavioral health services to enhance continuity of care.
• Assess medical necessity and authorize appropriate waiver services.
• Coordinate ICT meetings for service approval or denial.
• Travel up to 25–40% may be required depending on state/contractual requirements.

Skills

Care management

Care coordination

LTSS

Documentation

Communication

Problem solving

Time management

Microsoft Office

Driver's license

Education

Bachelor's degree in health care

Tools

Microsoft Office Suite

Job description

Molina Healthcare in Illinois is seeking a care management professional to support LTSS coordination and member care across settings. You will collaborate with the multidisciplinary team to develop and monitor care plans, including waiver services, with an emphasis on improving outcomes and controlling costs.

The role involves assessing medical necessity, coordinating with providers, and navigating systems and resources while maintaining effective communication with members and caregivers.