Care Manager, LTSS

Molina Healthcare•Long Beach, WI

13d•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 for members with high-need potential, support progress toward desired outcomes, and contribute to quality, cost-effective care. The position is remote, with travel throughout Eau Claire County, Wisconsin for member visits. Estimated local travel is 25–40%, depending on state and contractual requirements. The Care Manager completes comprehensive assessments within regulated timelines, including required in-person home visits; facilitates waiver enrollment and disenrollment; develops and monitors care plans and waiver service plans; coordinates services and resources; assesses medical necessity and authorizes appropriate waiver services; and supports members in addressing barriers to care. The role also facilitates interdisciplinary care team meetings, identifies critical incidents and prevention plans, and uses motivational interviewing and Molina clinical guideposts to educate and support members.

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 in care management; experience in a medical or behavioral health setting, or an equivalent combination of relevant education and experience, may qualify.
Clinical licensure or certification is required 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 adapt to diverse populations, personalities, and personal situations.
Proactive, detail-oriented approach; ability to work independently with minimal supervision and self-motivation.
Ability to respond to communications, remain calm in high-pressure situations, and 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

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 health care professionals, and the member's support network.
Monitor care plans to 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 approvals or denials and informal team collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate change during member contacts.
Assess barriers to care and coordinate assistance with psychosocial, financial, and medical concerns.
Identify critical incidents and develop prevention plans to support member health and welfare.
Collaborate with licensed care managers and leadership as needed or required.
Travel locally for member visits, estimated at 25–40% depending on state and contractual requirements.