Care Manager, LTSS

Molina Healthcare•Long Beach, WI

5d•Remote

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, supporting progress toward desired outcomes and contributing to quality, cost-effective member care. The role is remote, with travel throughout Chippewa, Eau Claire, and St. Croix Counties, Wisconsin, for member visits. Estimated local travel may be 25–40%, based on state and contractual requirements.

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 in care management, or 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 board 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 approach when working with diverse populations, personalities, and personal situations.
Ability to work proactively and with attention to detail.
Ability to work independently with minimal supervision and demonstrate self-motivation.
Ability to respond promptly in all forms of communication and remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Time-management and prioritization skills, including the ability to manage multiple projects and adapt to change.
Problem-solving skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office or 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 is required.

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 on an ongoing basis, 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 about appropriate funding sources.
Facilitate interdisciplinary care team meetings for service approval or denial and support informal interdisciplinary collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate change during member contacts.
Assess barriers to care and coordinate care and assistance to address members’ psychosocial, financial, and medical concerns.
Identify critical incidents and develop prevention plans to help ensure member health and welfare.
Collaborate with licensed care managers and leadership as needed or required.
Travel locally for member visits as required, estimated at 25–40% based on state and contractual requirements.