Care Manager, LTSS

Molina Healthcare•Long Beach, WI

10d•Remote

About The Position

The Care Manager, LTSS provides support for care management and care coordination activities specific to long-term services and supports (LTSS). The role collaborates with a multidisciplinary team to coordinate integrated care across the continuum for members with high-need potential, support progress toward desired outcomes, and contribute to quality and cost-effective care. This position is remote, with member visits throughout Jefferson County, Wisconsin. Local travel is estimated at 25–40%, based on state and contractual requirements. In-person home visits may be required as part of member assessments.

Requirements

At least 2 years of health care experience, including at least 1 year working with persons with disabilities or chronic conditions in LTSS and 1 year of care management experience; alternatively, experience in a medical and/or behavioral health setting or an equivalent combination of relevant education and experience.
Clinical licensure and/or certification only when required by state contract, regulation, business operating model, or state licensing mandates; any required license must be active and unrestricted in the state of practice.
A bachelor’s degree in a health care-related field may be required in some states, depending on state or contractual requirements.
Valid and unrestricted driver’s license, reliable transportation, and adequate auto insurance for job-related travel, unless otherwise required by law.
Demonstrated knowledge of community resources.
Ability to work in varied settings and adjust work style when serving diverse populations and navigating different personalities and personal situations.
Ability to work proactively and with attention to detail.
Ability to work independently with minimal supervision and demonstrate self-motivation.
Responsiveness in all forms of communication 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 simultaneously, and adaptability to change.
Problem-solving skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office and applicable software, and ability to navigate online portals and databases.
In some states, at least 1 year of experience working directly with individuals with substance use disorders.

Nice To Haves

Experience working with populations that receive waiver services.

Responsibilities

Complete comprehensive member assessments within regulated timelines, including required in-person home visits.
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 member support networks.
Monitor care plans to evaluate 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 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 assistance addressing members’ psychosocial, financial, and medical concerns.
Identify critical incidents and develop prevention plans to help assure member health and welfare.
Collaborate with licensed care managers and leadership as needed or required.
Travel locally for member visits as required; estimated travel is 25–40%.