Care Manager, LTSS

Molina Healthcare•Long Beach, CA

About The Position

Job Summary Provides support for care management/care coordination long-term services and supports specific activities and 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. 50% estimated local travel may be required (based upon state/contractual requirements) .

Requirements

At least 2 years 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.
Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). Clinical licensure and/or certification required ONLY if required by state contract, regulation 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.
Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
Excellent problem-solving, and critical-thinking 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, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).

Nice To Haves

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.

Responsibilities

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.