Care Manager, LTSS - Polk / Dubuque Counties

Molina Healthcare•Long Beach, IA

9d•Remote

About The Position

The Care Manager provides support for long-term services and supports (LTSS) care management and coordination. The role collaborates with a multidisciplinary team to coordinate integrated care across the continuum for members with high-need potential, promote progress toward member outcomes, and contribute to quality, cost-effective care. This is a remote, field-based role serving Polk or Dubuque Counties, with an estimated 25–40% local travel that may be required based on state or contractual requirements.

Requirements

At least 2 years of health care experience, including at least 1 year working with people 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 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 work style when engaging 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 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 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.

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 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 professionals, and member support networks.
Monitor care plans, 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 support 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 approvals or denials 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 coordinate assistance for psychosocial, financial, and medical obstacles or concerns.
Identify critical incidents and develop prevention plans to protect member health and welfare.
Collaborate with licensed care managers and leadership as needed or required.