Mandarin

Molina Healthcare•Long Beach, NY

11d

About The Position

Provides support for care management and care coordination activities specific to long-term services and supports (LTSS). Collaborates with a multidisciplinary team to coordinate integrated care across the continuum for members with high-need potential. Supports member progress toward desired outcomes and contributes to providing quality, cost-effective care. The role may involve complex member cases and medication regimens, medication reconciliation, and an estimated 25–40% local travel, depending on state and contractual requirements. The position is for a bilingual candidate speaking Spanish, Cantonese, or Mandarin.

Requirements

At least 2 years of health care experience, including at least 1 year in care management, managed care, or a medical or behavioral health setting, and at least 1 year working with people with disabilities, chronic conditions, substance abuse disorders, or LTSS; an equivalent combination of relevant education and experience may qualify.
Active, unrestricted Registered Nurse (RN) license in the state of practice (New York).
A bachelor's degree in a health care-related field may be required in some states, depending on state or contractual requirements.
Valid, unrestricted driver's license, reliable transportation, and adequate auto insurance for job-related travel, unless otherwise required by law.
Ability to work proactively and with attention to detail.
Demonstrated knowledge of community resources.
Ability to work in varied settings and adapt to diverse populations, personalities, and personal situations.
Ability to work independently with minimal supervision and demonstrate self-motivation.
Responsive communication skills and ability to remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Time-management and prioritization skills; ability to manage multiple projects and adapt to change.
Problem-solving skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office suite and applicable software programs.
In some states, at least 1 year of experience working directly with individuals with substance use disorders is required.
Bilingual in Spanish, Cantonese, or Mandarin.

Nice To Haves

Certified Case Manager (CCM).
Experience working with populations that receive waiver services.

Responsibilities

Complete comprehensive member assessments within regulated timelines, including in-person home visits when required.
Facilitate comprehensive waiver enrollment and disenrollment processes.
Develop and implement care plans, including waiver service plans, in collaboration with members, caregivers, physicians, other appropriate health care professionals, and the member’s support network.
Monitor care plans on an ongoing basis, evaluate their effectiveness, document interventions and goal achievement, and recommend changes as appropriate.
Promote integration of behavioral health care, LTSS, and home and community resources to enhance continuity of care.
Assess medical necessity and authorize appropriate waiver services.
Evaluate covered benefits and advise members regarding appropriate funding sources.
Facilitate interdisciplinary care team (ICT) meetings for service approval or denial, as well as informal ICT collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Assess barriers to care and coordinate care and assistance to address psychosocial, financial, and medical concerns.
Identify critical incidents and develop prevention plans to help ensure member health and welfare.
Provide consultation, resources, and recommendations to peers as needed.
For RN care managers, manage complex member cases and medication regimens as assigned and conduct medication reconciliation as needed.
Travel locally as required; estimated travel is 25–40%, based on state and contractual requirements.