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Long-Term Services and Supports Case Coordinator
2 months ago
POSITION SUMMARY
Molina Healthcare is seeking a dedicated professional to join our Family Care program in Wisconsin. This role involves collaborating with members, healthcare providers, and multidisciplinary teams to assess, facilitate, and coordinate comprehensive care across various services, including behavioral health and long-term care for individuals with significant needs.
The Case Coordinator will ensure that patients achieve their health goals through high-quality, medically appropriate, and cost-effective care tailored to their specific conditions and service locations.
KEY RESPONSIBILITIES1. Conduct thorough face-to-face assessments of members within established timelines.
2. Manage the waiver enrollment and disenrollment processes effectively.
3. Develop and execute a personalized case management plan in partnership with the member, their support network, and relevant healthcare professionals to meet the member's needs and aspirations.
4. Continuously monitor and evaluate the care plan's effectiveness, documenting interventions and outcomes while recommending necessary adjustments.5. Foster the integration of services, including behavioral health and long-term supports, to ensure continuity of care for Molina members.
6. Assess medical necessity and authorize appropriate waiver services.7. Provide guidance on covered benefits and funding sources.
8. Conduct home visits as required.
9. Facilitate interdisciplinary care team meetings to discuss service approvals or denials and encourage informal collaboration.
10. Utilize motivational interviewing techniques and Molina's clinical guidelines to educate and empower members during interactions.
11. Identify barriers to care and provide coordination and support to address psychosocial, financial, and medical challenges.
12. Recognize critical incidents and formulate prevention strategies to safeguard members' health and welfare.13. Offer consultation and education to non-RN case managers as needed.
14. Manage cases involving members with complex medical conditions and medication regimens.
15. Perform medication reconciliation when necessary.
Travel requirements: 50-75% travel expected.
QUALIFICATIONS
Education:
Graduate from an accredited nursing program.
Experience:
Minimum of 1 year working with individuals with disabilities or chronic conditions and Long-Term Services & Supports.
1-3 years in case management, disease management, managed care, or medical/behavioral health environments.
Licensure:
Active, unrestricted State Registered Nursing license (RN) in good standing.
If fieldwork is required, a valid driver's license with a clean driving record is necessary, along with reliable transportation.
STATE-SPECIFIC REQUIREMENTSVirginia:
A minimum of one year of experience working directly with individuals with Substance Use Disorders is required.
Preferred Education:
Bachelor's Degree in Nursing.
Preferred Experience:
3-5 years in case management, disease management, managed care, or medical/behavioral health settings.
1 year of experience working with populations receiving waiver services.
Preferred Licensure:
Active and unrestricted Certified Case Manager (CCM).
Note:
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. We offer a competitive benefits and compensation package.
