Care Manager, LTSS

Molina Healthcare•Peoria, IL

4d•$25 - $49

About The Position

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 aims to help members progress toward desired outcomes and contribute to quality, cost-effective care. Responsibilities include completing comprehensive assessments within regulated timelines, including in-person home visits when required; supporting waiver enrollment and disenrollment; and developing 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 services; evaluates medical necessity and authorizes appropriate waiver services; and advises members about covered benefits and funding sources. The role also facilitates interdisciplinary care team meetings, uses motivational interviewing and Molina clinical guideposts to support members, identifies barriers to care and critical incidents, and coordinates assistance and prevention plans. Collaboration with licensed care managers and leadership may be required. Estimated local travel may be 25–40%, depending on state and 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 in care management, a medical or behavioral health setting, or an equivalent combination of relevant education and experience.
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 adjust approach when working 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 across communication channels 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, 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 member support networks.
Monitor care plans on an ongoing basis, evaluate effectiveness, document interventions and goal achievement, and recommend changes.
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 approval or denial and informal team collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Assess barriers to care and coordinate assistance for members facing psychosocial, financial, or medical obstacles.
Identify critical incidents and develop prevention plans to support member health and welfare.
Collaborate with licensed care managers and leadership as needed or required.