Care Manager, LTSS

Molina Healthcare•Rockford, IL

4d•$25 - $49

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 member care across the continuum, particularly for members with high-need potential. Works to support members’ progress toward desired outcomes and contribute to quality, cost-effective care. The role includes completing comprehensive assessments, facilitating waiver enrollment and disenrollment, developing and monitoring care plans, coordinating services and resources, assessing medical necessity, authorizing appropriate waiver services, and supporting members in overcoming barriers to care. Local travel of an estimated 25–40% may be required, depending 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 is required 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 varied settings and adjust 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.
Ability to respond across 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 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.

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 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 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 appropriately regarding funding sources.
Facilitate interdisciplinary care team (ICT) meetings for service approval or denial and support informal ICT collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Assess barriers to care and provide care coordination and assistance with psychosocial, financial, and medical obstacles or 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 as required; estimated travel is 25–40%, based on state and contractual requirements.