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Iowa Case Manager, LTSS

2 months ago

Des Moines, Iowa, United States Molina Healthcare Full time
Job Summary

Molina Healthcare Services (HCS) collaborates 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. HCS staff 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.

Key Responsibilities
  • Conduct comprehensive assessments of members per regulated timelines.
  • Facilitate comprehensive waiver enrollment and disenrollment processes.
  • Develop and implement 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.
  • Perform ongoing monitoring of the care plan to evaluate effectiveness, document interventions, and goal achievement, and suggest changes accordingly.
  • Promote 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.
  • Assess for medical necessity and authorize all appropriate waiver services.
  • Evaluate covered benefits and advise appropriately regarding funding source.
  • Conduct face-to-face or home visits as required.
  • Facilitate interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration.
  • Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate change during member contacts.
  • Assess for barriers to care, provide care coordination, and assistance to members to address psycho/social, financial, and medical obstacles concerns.
  • Identify critical incidents and develop prevention plans to assure member's health and welfare.
  • 50-75% local travel required.
Requirements
  • Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) 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.
About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.