Care Manager, LTSS - Cerro Gordo, Hancock, Kossuth Cos.

Molina Healthcare•Long Beach, IA

6d•Remote

About The Position

This remote, field-based role provides support for care management and care coordination activities specific to long-term services and supports (LTSS). The Care Manager collaborates with a multidisciplinary team to coordinate integrated member care across the continuum, particularly for members with high-need potential. The role focuses on helping members progress toward desired outcomes while contributing to quality, cost-effective care. The position involves comprehensive member assessments, waiver enrollment and disenrollment, collaborative care-plan development and monitoring, service integration, assessment of medical necessity, and authorization of appropriate waiver services. The Care Manager also coordinates interdisciplinary care team meetings, educates and motivates members, addresses barriers to care, and identifies critical incidents and prevention plans. This is a remote field-based position with an estimated 25–40% local travel, which may vary 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 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 board licensing mandates; any license held 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 a variety of settings and adjust work style when working with diverse populations, personalities, and personal situations.
Ability to work proactively and demonstrate 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 focus on multiple projects simultaneously, and adaptability to change.
Problem-solving skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office or applicable software programs 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

Certified Case Manager (CCM), Licensed Vocational Nurse (LVN), or Licensed Practical Nurse (LPN); any license must be active and unrestricted in the state of practice.
Experience working with populations that receive waiver services.

Responsibilities

Complete comprehensive member assessments within regulated timelines, including in-person home visits as 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 to evaluate effectiveness, document interventions and goal achievement, and suggest 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 appropriately about funding sources.
Facilitate interdisciplinary care team (ICT) meetings for service approval or denial and informal ICT collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate change during member contacts.
Assess barriers to care and provide care coordination and assistance to address psychosocial, financial, and medical obstacles or concerns.
Identify critical incidents and develop prevention plans to assure member health and welfare.
Collaborate with licensed care managers and leadership as needed or required.
Travel locally as needed; estimated travel is 25–40%, based on state and contractual requirements.