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Case Manager
2 months ago
Job Description Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. Job Duties • Completes clinical assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers from the assessment. • Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member case load for regular outreach and management. Operates under productivity and outcome standards • Promotes integration of services for members including behavioral health care and long term services and supports to enhance the continuity of care for Molina members. • May implement specific Molina wellness programs i.e. asthma and depression disease management. • Facilitates interdisciplinary care team 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 RN case managers/supervisors as needed or required • Case managers in Behavioral Health and Social Science fields may provide consultation, resources and recommendations to peers as needed • Local travel of up to 40% may be required, depending on the complexity level of the assigned members, particular state-specific regulations, or whether the Case Manager position is located within Molina’s Central Programs unit. Job Qualifications REQUIRED EDUCATION: Graduate from an Accredited School of Nursing Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or Master's Degree (preferably in a social science, psychology, gerontology, public health or social work or related field. REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: 2+ years in case management, disease management, managed care or medical or behavioral health settings. Experience with working with persons with severe and persistent mental health concerns and serious emotional disturbances, to include substance use disorder and foster care 2+ years with discharge planning coordination from different care settings Excellent communication skills, both verbal and written. Minimum of 1-3 years data entry skills and minimum 1+ years’ experience utilizing a clinical platform. Knowledge and experience with coordination specific to behavioral health “whole person” care principles Knowledge and experience managing chronic health conditions. Min 2+ years’ experience with Microsoft applications: PowerPoint, Excel, Word 2+ years’ experience using a Clinical documentation software/platform REQUIRED LICENSE, CERTIFICATION, ASSOCIATION: Master’s level behavioral health therapist, to include any of the following: Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified in Health Education and Promotion (CHEP), Licensed Professional Counselor (LPC/LPCC), LMFT License must be active, unrestricted and in good standing. Must have valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation. PREFERRED EXPERIENCE: 3+ years in behavioral health case management, disease management, managed care settings. Field-based case management or home health experience. PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: Certified Case Manager (CCM), PHYSICAL DEMANDS: Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. #PJCorp #LI-AC1 Pay Range: $21.6 - $46.81 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
