Field Case Manager, LTSS
2 days ago
Job Summary:
Molina Healthcare Services (HCS) is seeking a skilled Field Case Manager to join our Long-Term Services and Supports (LTSS) team. As a Field Case Manager, you will work with our Medicaid members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care.
Key Responsibilities:
- Conduct face-to-face comprehensive assessments of members per regulated timelines.
- 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.
- Perform ongoing monitoring of the care plan to evaluate effectiveness, document interventions, and suggest changes accordingly.
- Promote integration of services for members, including behavioral health care and long-term services and supports, 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.
- Provide consultation, recommendations, and education as appropriate to non-RN case managers.
- Work cases with members who have complex medical conditions and medication regimens.
- Conduct medication reconciliation when needed.
Requirements:
- Graduate from an Accredited School of Nursing.
- 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.
- Active, unrestricted State Registered Nursing license (RN) in good standing.
- If field work is required, 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.
Preferred Qualifications:
- Bachelor's Degree in Nursing.
- 3-5 years in case management, disease management, managed care, or medical or behavioral health settings.
- 1 year experience working with population who receive waiver services.
- Active and unrestricted Certified Case Manager (CCM).
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $23.76 - $51.49 / HOURLY
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