Case Manager: California
5 days ago
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- Completes clinical assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers from the assessment.
- Develops and implements a case management 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.
- Conducts telephonic, face-to-face, or home visits as required.
- Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions, and goal achievement, and suggests changes accordingly.
- Maintains ongoing member case load for regular outreach and management.
- Promotes integration of services for members, including behavioral health care and long-term services and supports, to enhance the continuity of care for Molina members.
- May implement specific Molina wellness programs, such as asthma and depression disease management.
- Facilitates interdisciplinary care team meetings and informal ICT collaboration.
- Uses motivational interviewing and Molina clinical guideposts to educate, support, and motivate change during member contacts.
- Assesses for barriers to care, provides care coordination, and assistance to members to address concerns.
- Collaborates with RN case managers/supervisors as needed or required.
- Case managers in Behavioral Health and Social Science fields may provide consultation, resources, and recommendations to peers as needed.
- Local travel of up to 40% may be required, depending on the complexity level of the assigned members, particular state-specific regulations, or whether the Case Manager position is located within Molina's Central Programs unit.
- Any of the following: Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or Master's Degree (preferably in a social science, psychology, gerontology, public health, or social work or related field).
- 1-3 years in case management, disease management, managed care, or medical or behavioral health settings.
- If license required for the job, license must be active, unrestricted, and in good standing.
- Must have a valid driver's license with a good driving record and be able to drive within applicable state or locality with reliable transportation.
- State-specific requirements apply.
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