Field Case Manager, LTSS - LVN or Social Worker

Molina Healthcare • Brownsville, TX

443d • $97,365 - $97,365

About The Position

The Case Manager position at Molina Healthcare Services is designed for TX licensed LVNs or Social Workers in the Brownsville area. The role involves conducting face-to-face assessments with Medicaid members in their homes to determine necessary services. The Case Manager will work collaboratively with members, caregivers, and healthcare professionals to develop and implement care plans, ensuring quality and cost-effective care for individuals with high needs. This position requires local travel and offers a structured work schedule from Monday to Friday, 8 AM to 5 PM CST.

Requirements

• Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work.
• At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports.
• 1-3 years in case management, disease management, managed care or medical or behavioral health settings.

Nice To Haves

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.
• 1 year experience working with population who receive waiver services.
• Active and unrestricted Certified Case Manager (CCM) certification.
• Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing.

Responsibilities

• Conduct face-to-face comprehensive assessments of members per regulated timelines.
• Facilitate comprehensive waiver enrollment and disenrollment processes.
• Develop and implement a case management plan in collaboration with the member and healthcare professionals.
• Perform ongoing monitoring of the care plan to evaluate effectiveness and suggest changes accordingly.
• Promote integration of services for members including behavioral health care and long-term services and supports.
• Assess for medical necessity and authorize all appropriate waiver services.
• Evaluate covered benefits and advise appropriately regarding funding sources.
• Conduct face-to-face or home visits as required.
• Facilitate interdisciplinary care team meetings for service approval or denial.
• Use motivational interviewing to educate and support members during contacts.
• Assess for barriers to care and provide care coordination to address concerns.
• Identify critical incidents and develop prevention plans to assure member health and welfare.

Benefits

• Mileage reimbursement as part of the benefits package.
• Competitive benefits and compensation package.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Associate degree