Long-Term Services and Supports Case Manager

2 weeks ago

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

Position Summary

Molina Healthcare Services (HCS) collaborates with members, healthcare providers, and a multidisciplinary team to evaluate, facilitate, plan, and coordinate a holistic delivery of care across various domains, 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 service environment.

Key Responsibilities

  • Conduct comprehensive in-person assessments of members within mandated timelines.
  • Oversee the complete waiver enrollment and disenrollment processes.
  • Design and execute a tailored case management strategy, including a waiver service plan, in partnership with the member, their caregivers, physicians, and relevant healthcare professionals to meet the member's needs and aspirations.
  • Continuously monitor the effectiveness of the care plan, documenting interventions and achievements, and recommending adjustments as necessary.
  • Encourage the integration of services for members, encompassing behavioral health and long-term services and supports, to improve the continuity of care.
  • Evaluate medical necessity and authorize suitable waiver services.
  • Assess covered benefits and provide guidance on funding sources.
  • Perform face-to-face or home visits as required.
  • Facilitate interdisciplinary care team meetings to discuss service approvals or denials and foster informal collaboration.
  • Utilize motivational interviewing techniques and Molina clinical guidelines to educate and inspire change during member interactions.
  • Identify barriers to care and provide coordination and support to address psychosocial, financial, and medical challenges.
  • Recognize critical incidents and develop preventive strategies to ensure the health and safety of members.
  • Offer consultation, recommendations, and educational support to non-RN case managers.
  • Manage cases involving members with complex medical conditions and medication regimens.
  • Conduct medication reconciliation as necessary.
  • Travel required: 50-75%.

Qualifications

Education

Graduate from an Accredited School of Nursing.

Experience

  • 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 required, a valid driver's license with a clean driving record is necessary, along with reliable transportation.

State-Specific Requirements

Virginia: At least one year of experience working directly with individuals with Substance Use Disorders.

Preferred Qualifications

Education

Bachelor's Degree in Nursing.

Experience

  • 3-5 years 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.

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