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LTSS Case Management Specialist

2 months ago

Oshkosh, Wisconsin, United States Molina Healthcare Full time
Job Overview

Position Summary

Molina Healthcare Services (HCS) collaborates with members, healthcare providers, and multidisciplinary teams to evaluate, facilitate, plan, and coordinate a comprehensive 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 location of service.

Essential Knowledge, Skills, and Abilities

  • Conducts in-person comprehensive evaluations of members within regulated timelines.
  • Facilitates the enrollment and disenrollment processes for comprehensive waivers.
  • Creates and implements a case management strategy, including a waiver service plan, in partnership with the member, caregiver, physician, and other relevant healthcare professionals to meet the member's needs and objectives.
  • Monitors the effectiveness of the care plan continuously, documenting interventions and achievements, and recommending adjustments as necessary.
  • Encourages the integration of services for members, encompassing behavioral health care and long-term services and supports, to enhance continuity of care.
  • Evaluates medical necessity and authorizes all relevant waiver services.
  • Assesses covered benefits and provides guidance on funding sources.
  • Conducts in-person or home visits as required.
  • Facilitates interdisciplinary care team meetings to discuss service approvals or denials and foster informal collaboration.
  • Utilizes motivational interviewing techniques and Molina clinical guidelines to educate, support, and inspire change during member interactions.
  • Identifies barriers to care and coordinates assistance for members to address psychosocial, financial, and medical challenges.
  • Recognizes critical incidents and formulates prevention strategies to ensure the health and safety of members.
  • Offers consultation, recommendations, and education to non-RN case managers as appropriate.
  • Manages cases involving members with complex medical conditions and medication regimens.
  • Performs medication reconciliation when necessary.
  • Travel requirements: 50-75%.

Qualifications

Education Requirements

Graduate from an Accredited School of Nursing.

Experience Requirements

  • A minimum of 1 year of experience working with individuals with disabilities or chronic conditions and Long-Term Services & Supports.
  • 1-3 years of experience in case management, disease management, managed care, or medical/behavioral health environments.

Licensure and Certification

  • Active, unrestricted State Registered Nursing license (RN) in good standing.
  • If fieldwork is necessary, a valid driver's license with a good driving record is required, along with reliable transportation.

State-Specific Requirements

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

Preferred Licensure and Certification

Active and unrestricted Certified Case Manager (CCM).

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

Pay Range: $51.49 / HOURLY
*Actual compensation may vary based on geographic location, work experience, education, and/or skill level.