Care Manager, LTSS

Molina Healthcare•Long Beach, CA

11d•Remote

About The Position

Provides support for long-term services and supports (LTSS)-specific care management and care coordination activities. Collaborates with a multidisciplinary team to coordinate integrated member care across the continuum, particularly for members with high-need potential. Works to support member progress toward desired outcomes and contribute to quality, cost-effective care. The role includes completing comprehensive assessments within regulated timelines, including required in-person home visits; facilitating waiver enrollment and disenrollment; and developing, implementing, and monitoring care plans and waiver service plans in collaboration with members, caregivers, physicians, other health care professionals, and the member’s support network. The Care Manager promotes integration of behavioral health, LTSS, and community resources; assesses medical necessity and authorizes appropriate waiver services; evaluates covered benefits and advises on funding sources; and facilitates interdisciplinary care team meetings. The Care Manager uses motivational interviewing and clinical guideposts to educate and support members, identifies barriers to care and coordinates assistance, and identifies critical incidents and develops prevention plans to protect member health and welfare. The position is remote, with estimated local travel of 25–40% based on state and contractual requirements, including member visits throughout Jefferson County, Wisconsin.

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, 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 varied settings and adjust approach 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 to communications and 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 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.

Nice To Haves

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 health care professionals, and the member’s support network.
Monitor care plans on an ongoing basis, 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 regarding 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 assistance for psychosocial, financial, and medical 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, estimated at 25–40%, based on state and contractual requirements.