Telephonic Care Manager, LTSS - MUST RESIDE IN TEXAS

Molina Healthcare•Long Beach, TX

1d•Remote

About The Position

Provides support for long-term services and supports (LTSS)-specific care management and care coordination. The Care Manager collaborates with a multidisciplinary team to coordinate integrated care across the continuum for members with high-need potential, support progress toward desired outcomes, and contribute to quality and cost-effective care. This is a fully telephonic position, but the applicant must reside in Texas. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. CST. An estimated 25–40% local travel may be required based on state or contractual requirements, including in-person home visits when required.

Requirements

Must reside in Texas.
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 of care management experience, or experience in a medical and/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 license held 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 work-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.
Proactive, detail-oriented approach.
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; ability to manage multiple projects and adapt to change.
Problem-solving skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office Suite and 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.
Strong experience with Microsoft Office, especially 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.
LVN, LBSW, or LMSW credentials are described as ideal; 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 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 appropriate health care professionals, and member support networks.
Monitor care plans to evaluate effectiveness, document interventions and goal achievement, and suggest 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 appropriately regarding 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.
Assess barriers to care and coordinate care and assistance to address members’ psychosocial, financial, and medical concerns.
Identify critical incidents and develop prevention plans to assure member health and welfare.
Collaborate with licensed care managers and leadership as needed or required.