Care Manager for Long-Term Services and Supports

6 days ago

Irving, Texas, United States Molina Healthcare Full time
Job Summary

Molina Healthcare Services is seeking a skilled Care Manager to join our team. As a Care 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 develop individualized care plans.
  • Facilitate waiver enrollment and disenrollment processes, ensuring timely and accurate completion.
  • Collaborate with members, caregivers, physicians, and other healthcare professionals to develop and implement care plans that address member needs and goals.
  • Monitor care plans 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 continuity of care.
  • Assess medical necessity and authorize waiver services, ensuring compliance with regulatory requirements.
  • Evaluate covered benefits and advise members on funding sources.
  • Conduct face-to-face or home visits as required, providing education and support to members.
  • Facilitate interdisciplinary care team meetings to discuss service approvals and denials.
  • Utilize motivational interviewing and clinical guideposts to educate and support members in achieving their goals.
  • Identify barriers to care and provide care coordination and assistance to members to address psycho-social, financial, and medical obstacles.
  • Develop prevention plans to ensure member health and welfare.
  • Provide consultation, recommendations, and education to non-RN case managers as needed.
  • Work with members who have complex medical conditions and medication regimens, conducting medication reconciliation as necessary.

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 of experience in case management, disease management, managed care, or medical or behavioral health settings.
  • Active, unrestricted state registered nursing license (RN) in good standing.
  • Valid driver's license with a good driving record and reliable transportation (if field work is required).

Preferred Qualifications:

  • Bachelor's degree in nursing.
  • 3-5 years of experience in case management, disease management, managed care, or medical or behavioral health settings.
  • 1 year of experience working with populations who receive waiver services.
  • Active and unrestricted certified case manager (CCM) certification.

Molina Healthcare offers a competitive benefits and compensation package. We are an equal opportunity employer (EOE) and welcome applications from diverse candidates.

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