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Case Manager
1 month ago
Molina Healthcare Services (HCS) works with members, providers, and multidisciplinary team members 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 work to 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
- Conduct face-to-face comprehensive assessments of members per regulated timelines.
- Facilitate comprehensive waiver enrollment and disenrollment processes.
- 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 and member's support network to address the member needs and goals.
- Perform ongoing monitoring of the care plan to evaluate effectiveness, document interventions, and goal achievement, and suggest changes accordingly.
- Promote 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.
- 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.
- 50-75% travel required.
Requirements
Education
Graduate from an Accredited School of Nursing
Experience
- 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.
- Required License, Certification, Association
- Active, unrestricted State Registered Nursing license (RN) in good standing.
- If field work is required, Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
State Specific Requirements
Virginia:
Must have at least one year of experience working directly with individuals with Substance Use Disorders
Preferred Education
Bachelor's Degree in Nursing
Preferred Experience
- 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.
Preferred License, Certification, Association
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:
$51.49 / HOURLY