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Long-Term Services and Supports Case Manager

2 months ago

Oshkosh, Wisconsin, United States Molina Healthcare Full time
Job Overview

Position Summary

Molina Healthcare Services (HCS) collaborates with members, healthcare providers, and a multidisciplinary team to evaluate, facilitate, plan, and coordinate comprehensive care delivery across various settings, including behavioral health and long-term care, for individuals with significant needs. The HCS team is dedicated to ensuring that patients achieve their health goals through quality care that is both medically appropriate and cost-effective, tailored to the severity of their conditions and the service environment.

Key Responsibilities

  • Conducts in-person comprehensive evaluations of members within mandated timelines.
  • Manages the complete waiver enrollment and disenrollment processes.
  • 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.
  • Continuously monitors the effectiveness of the care plan, documenting interventions and progress towards goals, and recommends adjustments as necessary.
  • Facilitates the integration of services for members, including behavioral health and long-term services and supports, to enhance continuity of care.
  • Evaluates medical necessity and authorizes all relevant waiver services.
  • Assesses covered benefits and provides guidance on funding sources.
  • Conducts in-person or home visits as required.
  • Leads interdisciplinary care team meetings to review service approvals or denials and foster informal collaboration.
  • Utilizes motivational interviewing techniques and Molina clinical guidelines to educate and support members during 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, guidance, and education to non-RN case managers as needed.
  • Handles cases involving members with complex medical conditions and intricate medication regimens.
  • Performs medication reconciliation when necessary.
  • Travel requirements range from 50% to 75%.

Qualifications

Education

Graduate from an Accredited School of Nursing.

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 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: Minimum of one year of experience working directly with individuals with Substance Use Disorders.

Preferred Qualifications

Education

Bachelor's Degree in Nursing.

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.

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.