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Long-Term Services and Supports Case Manager

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 a multidisciplinary team to evaluate, facilitate, plan, and coordinate a comprehensive delivery of care across various settings, 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 location.

REQUIRED KNOWLEDGE/SKILLS/ABILITIES

  • Conducts in-person comprehensive evaluations of members within regulated timelines.
  • Manages the enrollment and disenrollment processes for comprehensive waivers.
  • Develops 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 support networks to meet the member's needs and objectives.
  • Continuously monitors the care plan to assess its effectiveness, document interventions and goal achievements, and recommend necessary adjustments.
  • Encourages the integration of services for members, encompassing behavioral health care and long-term services and supports, to enhance continuity of care.
  • Evaluates medical necessity and authorizes all relevant waiver services.
  • Reviews covered benefits and provides guidance regarding funding sources.
  • Performs in-person or home visits as required.
  • Facilitates interdisciplinary care team meetings for service approvals or denials and informal collaboration.
  • Utilizes motivational interviewing techniques and Molina clinical guidelines to educate, support, and inspire change during member interactions.
  • Identifies barriers to care, offering coordination and assistance to members to address psychosocial, financial, and medical challenges.
  • Recognizes critical incidents and formulates prevention strategies to ensure the health and safety of members.
  • Provides guidance, recommendations, and education as necessary to non-RN case managers.
  • Manages cases involving members with complex medical conditions and medication regimens.
  • Conducts medication reconciliation as needed.
  • % 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 able to drive within 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).

Molina Healthcare provides 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.