Care Coordinator for Long Term Services and Supports

3 weeks ago

Chaparral, United States Molina Healthcare Full time
Job Summary

Molina Healthcare Services (HCS) is seeking a skilled RN Case Manager to join our team. As a Care Coordinator for Long Term Services and Supports, you will work with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum. Your expertise will be essential in ensuring that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective.

Key Responsibilities
  • Completes face-to-face comprehensive assessments of members per regulated timelines.
  • Facilitates comprehensive waiver enrollment and disenrollment processes.
  • Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician, and/or other appropriate healthcare professionals and member's support network.
  • Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions, and goal achievement, and suggests changes accordingly.
  • Promotes integration of services for members, including behavioral health care and long-term services and supports, home and community to enhance the continuity of care for Molina members.
  • Assesses for medical necessity and authorizes all appropriate waiver services.
  • Evaluates covered benefits and advises appropriately regarding funding source.
  • Conducts face-to-face or home visits as required.
  • Facilitates interdisciplinary care team meetings for approval or denial of services 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 psycho/social, financial, and medical obstacles concerns.
  • Identifies critical incidents and develops prevention plans to assure member's health and welfare.
  • Provides consultation, recommendations, and education as appropriate to non-RN case managers.
  • Works cases with members who have complex medical conditions and medication regimens.
  • Conducts 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.
  • An Equal Opportunity Employer (EOE) M/F/D/V.

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