Long-Term Services and Supports Case Manager
2 weeks ago
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 services, 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.
Essential Knowledge, Skills, and Abilities
- Conducts in-person comprehensive evaluations of members within required timelines.
- Manages the enrollment and disenrollment processes for comprehensive waivers.
- Creates and executes a case management strategy, including a waiver service plan, in partnership with the member, their caregiver, healthcare providers, and the member's support network to meet their needs and objectives.
- Continuously monitors the effectiveness of the care plan, documenting interventions and achievements, and recommending adjustments as necessary.
- Encourages the integration of services for members, encompassing behavioral health and long-term services and supports, to enhance continuity of care.
- Evaluates medical necessity and authorizes relevant waiver services.
- Reviews covered benefits and provides guidance on funding sources.
- Conducts in-person or home visits as needed.
- Facilitates interdisciplinary care team meetings to discuss service approvals or denials and promotes informal collaboration.
- Utilizes motivational interviewing techniques and Molina clinical guidelines to educate and support members during interactions.
- Identifies barriers to care and coordinates assistance for members facing psychosocial, financial, or medical challenges.
- Recognizes critical incidents and formulates prevention strategies to ensure the health and safety of members.
- Offers consultation and educational support to non-RN case managers as needed.
- Handles cases involving members with complex medical issues and medication management.
- Performs medication reconciliation when necessary.
- Travel requirements: 50-75%.
Qualifications
Required Education
Graduate from an accredited nursing program.
Required Experience
- A minimum of 1 year of experience working with individuals with disabilities or chronic conditions and in 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 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 is committed to providing 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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