Care Manager - Must live in UT

Molina Healthcare•Long Beach, CA

11h•Hybrid

About The Position

Responsible for reviewing Utah Medicaid claims data to identify members who meet Restriction Program criteria, including overutilization of emergency department services, multiple prescribers, multiple pharmacies, and potential overuse of controlled substances. Manages an assigned caseload of restricted members for a 12-month intervention period, providing care coordination and monitoring to support appropriate utilization of Medicaid benefits. Collaborates with providers to implement and maintain member lock-in assignments to a designated provider and pharmacy, promote quality outcomes, and ensure compliance with Utah Medicaid program requirements.

Requirements

At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.
Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates.
Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
Demonstrated knowledge of community resources.
Ability to operate proactively and demonstrate detail-oriented work.
Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
Ability to work independently, with minimal supervision and self-motivation.
Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
Excellent problem-solving and critical-thinking skills.
Strong verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

Nice To Haves

In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).

Responsibilities

Completes assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments.
Develops and implements care plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals.
Conducts telephonic, face-to-face or home visits as required.
Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
Maintains ongoing member caseload for regular outreach and management.
Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration.
Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
Collaborates with licensed care managers/leadership as needed or required.