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Case Management Specialist for Medicaid and Medicare Services
2 months ago
JOB DESCRIPTION
Overview
Molina Healthcare Services (HCS) collaborates with members, healthcare providers, and a multidisciplinary team to evaluate, facilitate, plan, and coordinate a comprehensive delivery of care across various services, including behavioral health and long-term care, for individuals with significant needs. The HCS team is dedicated to ensuring that patients achieve their desired health outcomes through quality care that is both medically appropriate and cost-effective, tailored to the severity of their conditions and the service environment.
This role is integral to our Senior Whole Health initiative, which operates as a Managed Long-Term Care (MLTC) and Medicaid Advantage (MAP) plan. These programs enhance the provision of long-term services to individuals who are chronically ill or disabled and qualify for Medicaid and Medicare. We are seeking Case Managers who hold a LMSW or LCSW license. Experience in Long-term Services and Supports (LTSS) is highly valued. Candidates should possess strong organizational and time management abilities, and be comfortable working in a fast-paced, high-volume setting.
This is a remote position that requires occasional field travel. Team members may be required to attend in-office training or meetings and conduct high-risk field visits as necessary.
Work Schedule: Monday - Friday, 8:00 AM - 5:00 PM EST. On-call responsibilities after hours (5 PM - 8 AM) on a rotational basis.
KEY RESPONSIBILITIES
- Conduct face-to-face comprehensive assessments of members within regulated timelines.
- Facilitate the enrollment and disenrollment processes for comprehensive waivers.
- Develop and implement a tailored case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician, and other relevant healthcare professionals.
- Monitor the effectiveness of the care plan, documenting interventions and goal achievements, and recommend adjustments as needed.
- Promote the integration of services for members, including behavioral health care and long-term services and supports, to enhance continuity of care.
- Assess medical necessity and authorize appropriate waiver services.
- Evaluate covered benefits and provide guidance regarding funding sources.
- Conduct face-to-face or home visits as required.
- Facilitate interdisciplinary care team meetings for service approvals or denials.
- Utilize motivational interviewing techniques and Molina clinical guidelines to educate and support members during interactions.
- Identify barriers to care and provide coordination and assistance to address psychosocial, financial, and medical concerns.
- Recognize critical incidents and develop prevention strategies to ensure member health and safety.
- Expect 50-75% local travel as part of the role.
JOB QUALIFICATIONS
REQUIRED EDUCATION:
- Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) program, or a Bachelor's or Master's degree in social science, psychology, gerontology, public health, or social work, or a combination of education and experience that provides an equivalent background.
REQUIRED EXPERIENCE:
- A minimum of 1 year of experience working with individuals with disabilities or chronic conditions and Long-Term Services & Supports.
- 1-3 years of experience in case management, disease management, managed care, or medical or behavioral health settings.
PREFERRED EXPERIENCE:
- 3-5 years of experience in case management, disease management, managed care, or medical or behavioral health settings.
- 1 year of experience working with populations receiving waiver services.
- Experience in Managed Long-Term Care (MLTC).
- Experience in Long-Term Services and Supports (LTSS).
- Experience in home health settings.
- Experience working with the geriatric population.
- Ability to manage a high caseload, up to 200 cases.
- Must thrive in a fast-paced, high-volume environment.
- Bilingual candidates are encouraged to apply.
PREFERRED LICENSES AND CERTIFICATIONS:
- Active and unrestricted Certified Case Manager (CCM) certification.
- Active, unrestricted State Nursing license (LVN/LPN) or Clinical Social Worker license in good standing.
- NY LMSW or LCSW license.
Additional Requirements:
A valid driver's license with a good driving record and the ability to drive within the applicable state or locality with reliable transportation.
Molina Healthcare is committed to providing a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time
