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Long-Term Services and Supports Case Manager
2 months ago
Position Summary
Family Care with My Choice Wisconsin - must reside in WI
Role Summary
Molina Healthcare Services (HCS) collaborates with members, healthcare providers, and multidisciplinary teams 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. HCS personnel strive to ensure 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 setting.
Essential Knowledge, Skills, and Abilities
- Conducts in-person comprehensive evaluations of members within mandated timelines.
- Facilitates the enrollment and disenrollment processes for comprehensive waivers.
- Creates and executes a case management strategy, including a waiver service plan, in partnership with the member, their caregivers, physicians, and other relevant healthcare professionals to meet the member's needs and aspirations.
- Monitors the effectiveness of the care plan, documenting interventions and progress toward goals, and recommends adjustments as necessary.
- Encourages the integration of services for members, including behavioral health and long-term services and supports, to improve continuity of care.
- Evaluates medical necessity and authorizes all relevant waiver services.
- Assesses covered benefits and provides guidance regarding funding sources.
- Conducts in-person or home visits as required.
- Facilitates interdisciplinary care team meetings to discuss service approvals or denials and informal collaboration.
- Utilizes motivational interviewing techniques and Molina clinical guidelines to educate, support, and inspire change during member interactions.
- Identifies barriers to care and coordinates assistance for members to address psychosocial, financial, and medical challenges.
- Recognizes critical incidents and formulates prevention strategies to ensure the health and safety of members.
- Offers consultation, recommendations, and education to non-RN case managers as appropriate.
- Manages cases involving members with complex medical conditions and medication management.
- Conducts medication reconciliation as necessary.
- Travel requirements: 50-75%.
Qualifications
Education Requirements
Graduate from an Accredited School of Nursing.
Experience Requirements
- 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 environments.
Licensure and Certification
- Active, unrestricted State Registered Nursing license (RN) in good standing.
- If fieldwork is necessary, a valid driver's license with a clean driving record is required, along with reliable transportation.
State-Specific Requirements
Virginia: At least one year of experience working directly with individuals with Substance Use Disorders is required.
Preferred Education
Bachelor's Degree in Nursing.
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.
Preferred Licensure and Certification
Active and unrestricted Certified Case Manager (CCM).
Molina Healthcare provides a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $51.49 / HOURLY
*Actual compensation may vary based on geographic location, work experience, education, and/or skill level.
