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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 a comprehensive delivery of care across various services, including behavioral health and long-term care, for individuals with significant needs. The HCS team is dedicated to ensuring 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 thorough in-person assessments of members within mandated timelines.
  • Manages the enrollment and disenrollment processes for comprehensive waivers.
  • Creates and executes a tailored case management strategy, including a waiver service plan, in partnership with the member, their caregivers, healthcare providers, and support networks to meet the member's needs and aspirations.
  • Continuously monitors the effectiveness of the care plan, documenting interventions and achievements, and recommends adjustments as necessary.
  • Facilitates the integration of services for members, encompassing behavioral health and long-term support services, to enhance care continuity.
  • Evaluates medical necessity and authorizes all relevant waiver services.
  • Assesses available benefits and provides guidance on funding sources.
  • Conducts necessary in-person or home visits.
  • Leads interdisciplinary care team meetings to discuss service approvals or denials and fosters informal collaboration.
  • Utilizes motivational interviewing techniques and Molina clinical guidelines to educate and empower members during interactions.
  • Identifies barriers to care and provides coordination and support to address psychosocial, financial, and medical challenges.
  • Recognizes critical incidents and formulates prevention strategies to ensure the health and safety of members.
  • Offers consultation and educational support to non-RN case managers as needed.
  • Handles cases involving members with intricate medical conditions and complex medication regimens.
  • Performs medication reconciliation when necessary.
  • Travel requirements range from 50% to 75%.

Qualifications

Required Education

Graduation from an Accredited Nursing Program.

Required 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/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 experiencing 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/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.