Telephonic Care Manager, LTSS - MUST RESIDE IN TEXAS

Molina Healthcare•Long Beach, CA

2d•Remote

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 focuses on helping members progress toward desired outcomes and contributing to quality, cost-effective care. The position is fully telephonic, but the employee must reside in Texas. In-person home visits may be required, and estimated local travel may be 25–40% depending on state and contractual requirements. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. CST. Strong Microsoft Office skills are necessary, especially in Outlook, Excel, Teams, and OneNote.

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 only when required by state contract, regulation, business operating model, or state board mandates; any 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 demonstrate self-motivation.
Ability to respond effectively in all forms of communication 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 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 is required.
Applicants must reside in Texas.
Solid Microsoft Office Suite experience is necessary, especially with Outlook, Excel, Teams, and OneNote.

Nice To Haves

Certified Case Manager (CCM).
Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN), with an active and unrestricted license in the state of practice.
Experience working with populations that receive waiver services.
The posting identifies LVN, LBSW, or LMSW as ideal credentials; candidates with at least 3 years of case management experience will also be considered.

Responsibilities

Complete comprehensive member assessments within regulated timelines, including in-person home visits when required.
Facilitate comprehensive waiver enrollment and disenrollment processes.
Develop and implement care plans, including waiver service plans, in collaboration with members, caregivers, physicians or other health 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 applicable funding sources.
Facilitate interdisciplinary care team (ICT) meetings for service approval or denial and informal ICT collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Identify barriers to care and provide coordination and assistance for 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.