Iowa Case Manager, LTSS
2 days ago
Molina Healthcare Services (HCS) is seeking a skilled Case Manager to join our team. As a Case Manager, you will work with members, providers, and multidisciplinary teams 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.
Key Responsibilities- Completes face-to-face comprehensive assessments of members per regulated timelines.
- Facilitates comprehensive waiver enrollment and disenrollment processes.
- Develops and implements a case management plan, including a waiver service 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.
- Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions, and goal achievement, and suggests changes accordingly.
- Promotes integration of services for members, including behavioral health care and long-term services and supports, home and community to enhance the continuity of care for Molina members.
- Assesses for medical necessity and authorizes all appropriate waiver services.
- Evaluates covered benefits and advises appropriately regarding funding source.
- Conducts face-to-face or home visits as required.
- Facilitates interdisciplinary care team meetings for approval or denial of services 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 members to address psycho/social, financial, and medical obstacles concerns.
- Identifies critical incidents and develops prevention plans to assure member's health and welfare.
- Completion of an accredited Licensed Registered Nurse (RN) Program or Bachelor's or master's degree in a social science, psychology, gerontology, public health, or social work or any combination of education and experience that would provide an equivalent background.
- At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports.
- 1-3 years in case management, disease management, managed care, or medical or behavioral health settings.
- 3-5 years in case management, disease management, managed care, or medical or behavioral health settings.
- 1 year experience working with population who receive waiver services.
- Active and unrestricted Certified Case Manager (CCM)
- Active, unrestricted State Nursing license (LVN/LPN/RN) or Clinical Social Worker license in good standing
- Valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation
For the state of Wisconsin:
- Bachelor's degree or more advanced degree in the human services area and a minimum of one (1) year experience working with at least one of the Family Care target populations; or
- Bachelor's degree or more advanced degree in any area other than human services with a minimum of three (3) years' experience working with at least one of the Family Care target populations.
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