Care Coordinator, LTSS

4 days ago

Janesville, Wisconsin, United States Molina Healthcare Full time
Job Summary

Molina Healthcare Services (HCS) is seeking a skilled Case Manager, LTSS 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'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.

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. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $23.76 - $51.49 / HOURLY

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