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Community Care Coordinator, LTSS

2 months ago

Fort Worth, Texas, United States Molina Healthcare Full time

Internal Number:

JOB DESCRIPTION

Job Overview

Molina Healthcare Services (HCS) collaborates with members, healthcare providers, and interdisciplinary team members to evaluate, facilitate, strategize, and coordinate a holistic delivery of care across various domains, including behavioral health and long-term services, for individuals with significant care needs. HCS personnel strive to ensure that patients advance towards their desired health outcomes through quality care that is both medically appropriate and cost-efficient, tailored to the severity of their conditions and the care setting.

REQUIRED KNOWLEDGE/SKILLS/ABILITIES

  • Conducts in-person comprehensive evaluations of members within mandated timelines.
  • Manages the complete waiver enrollment and disenrollment processes.
  • Formulates and executes a case management strategy, including a waiver service plan, in partnership with the member, caregiver, physician, and/or other relevant healthcare professionals and the member's support network to meet the member's needs and objectives.
  • Performs continuous oversight of the care plan to assess its effectiveness, document interventions and goal achievements, and recommend modifications as necessary.
  • Encourages the integration of services for members, encompassing behavioral health care and long-term services and supports, to enhance continuity of care for Molina members.
  • Evaluates medical necessity and authorizes all suitable waiver services.
  • Reviews covered benefits and provides appropriate guidance regarding funding sources.
  • Conducts in-person or home visits as required.
  • Facilitates interdisciplinary care team meetings for service approval or denial and informal collaboration.
  • Utilizes motivational interviewing techniques and Molina clinical guidelines to educate, support, and inspire change during member interactions.
  • Identifies barriers to care, offers care coordination, and assists members in addressing psychosocial, financial, and medical challenges.
  • Recognizes critical incidents and formulates prevention strategies to ensure the member's health and safety.
  • Provides consultation, recommendations, and education as necessary to non-RN case managers.
  • Manages cases involving members with complex medical conditions and intricate medication regimens.
  • Conducts medication reconciliation when necessary.
  • % travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

  • Minimum of 1 year of experience working with individuals with disabilities or chronic conditions and Long-Term Services & Supports.
  • Experience in case management, disease management, managed care, or medical or behavioral health environments.

Required License, Certification, Association

  • Active, unrestricted State Registered Nursing license (RN) in good standing.
  • If fieldwork is necessary, must possess a valid driver's license with a good driving record and be capable of driving within the 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

  • Experience in case management, disease management, managed care, or medical or behavioral health settings.
  • 1 year of experience working with populations receiving waiver services.

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM).

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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Pay Range: $ - $ / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.