Long-Term Services Case Manager

3 weeks ago

Quitman, United States Molina Healthcare Full time

Internal Number:

JOB DESCRIPTION

Position Overview

Molina Healthcare Services (HCS) collaborates with members, healthcare providers, and multidisciplinary teams to evaluate, facilitate, plan, and coordinate a seamless delivery of care 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 desired health outcomes through quality care that is both medically appropriate and cost-effective, tailored to the severity of their conditions and the care environment.

ESSENTIAL KNOWLEDGE/SKILLS/ABILITIES

  • Conducts in-person comprehensive evaluations of members within mandated timelines.
  • Manages the enrollment and disenrollment processes for comprehensive waivers.
  • Formulates and executes a case management strategy, including a waiver service plan, in partnership with the member, their caregivers, healthcare providers, and the member's support network to meet their needs and objectives.
  • Performs continuous monitoring of the care plan to assess its effectiveness, document interventions and goal attainment, and recommend adjustments as necessary.
  • Encourages the integration of services for members, encompassing behavioral health and long-term services and supports, to improve continuity of care for Molina members.
  • Evaluates medical necessity and authorizes all relevant waiver services.
  • Reviews covered benefits and provides guidance regarding funding sources.
  • Conducts in-person or home visits as required.
  • Organizes interdisciplinary care team meetings for service approval or denial and informal collaboration.
  • Utilizes motivational interviewing techniques and Molina clinical guidelines to educate, support, and inspire change during member interactions.
  • Identifies barriers to care, providing coordination and assistance to members in addressing psychosocial, financial, and medical challenges.
  • Recognizes critical incidents and formulates prevention strategies to ensure the health and safety of members.
  • % local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

  • Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR a Bachelor's or Master's degree in social science, psychology, gerontology, public health, or social work OR any combination of education and experience that would provide an equivalent background.

REQUIRED EXPERIENCE:

  • A minimum of 1 year of experience working with individuals with disabilities or chronic conditions and Long-Term Services & Supports.
  • Experience in case management, disease management, managed care, or medical or behavioral health environments.

PREFERRED EXPERIENCE:

  • Experience in case management, disease management, managed care, or medical or behavioral health settings.
  • At least 1 year of experience working with populations receiving waiver services.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing

Valid driver's license with a good driving record and the ability to drive within applicable state or locality with reliable transportation.

Molina Healthcare provides a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $ - $ / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.

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