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:
• Conduct comprehensive assessments of members to identify their needs and goals.
• Develop and implement case management plans, including waiver service plans, in collaboration with members, caregivers, physicians, and other healthcare professionals.
• Monitor and evaluate the effectiveness of care plans, making adjustments as needed.
• Promote integration of services, including behavioral health care and long-term services and supports, to enhance continuity of care for Molina members.
• Assess medical necessity and authorize waiver services as needed.
• Evaluate covered benefits and advise members on funding sources.
• Conduct face-to-face or home visits as required.
• Facilitate interdisciplinary care team meetings and informal collaboration.
• Use motivational interviewing and clinical guideposts to educate and support members in achieving their goals.
• Identify barriers to care and provide care coordination and assistance to address psycho-social, financial, and medical obstacles.
• Develop prevention plans to ensure members' health and welfare.
Requirements:
• Bachelor's or master's degree in a social science, psychology, gerontology, public health, or social work, or equivalent education and experience.
• At least 1 year of experience working with persons with disabilities/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 in case management, disease management, managed care, or medical or behavioral health settings, and 1 year of experience working with populations receiving waiver services.
• Active and unrestricted Certified Case Manager (CCM) certification, or active Clinical Social Worker license in good standing, or valid driver's license with a good driving record and reliable transportation.
• State-specific requirements may apply, such as a bachelor's degree or more advanced degree in the human services area and a minimum of 1 year of experience working with at least one of the Family Care target populations, or a bachelor's degree or more advanced degree in any area other than human services with a minimum of 3 years' experience working with at least one of the Family Care target populations.
Molina Healthcare offers a competitive benefits and compensation package, and is an Equal Opportunity Employer (EOE) M/F/D/V.
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