Case Manager

3 weeks ago

Madison WI USA, United States Molina Healthcare Full time
Job Summary

Molina Healthcare Services (HCS) is seeking a skilled Case Manager to join our team. As a Case Manager, you will work with members, providers, and multidisciplinary teams 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.

Key Responsibilities:

• Conduct comprehensive assessments of members to identify their needs and goals.

• Develop and implement a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician, and other healthcare professionals.

• Monitor the care plan to evaluate effectiveness, document interventions, and suggest changes as needed.

• Promote integration of services for members, including behavioral health care and long-term services and supports, to enhance the continuity of care.

• Assess for medical necessity and authorize all appropriate waiver services.

• Evaluate covered benefits and advise on funding sources.

• 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.

• Identify critical incidents and develop prevention plans to assure member health and welfare.

Requirements

• Bachelor's or master's degree in a social science, psychology, gerontology, public health, or social work.

• 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.

Preferred Qualifications

• 3-5 years in case management, disease management, managed care, or medical or behavioral health settings.

• 1 year experience working with populations who receive waiver services.

• Active and unrestricted Certified Case Manager (CCM) certification.

• Clinical Social Worker license in good standing.

• Valid driver's license with a good driving record and reliable transportation.

State-Specific Requirements

For the state of Wisconsin:

• Bachelor's degree or more advanced degree in the human services area and a minimum of one (1) year experience working with at least one of the Family Care target populations; or

• Bachelor's degree or more advanced degree in any area other than human services with a minimum of three (3) years' experience working with at least one of the Family Care target populations.

Pay Range:
$21.6 - $46.81 / HOURLY

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