Care Manager, LTSS - Calhoun/Carroll Co.
About the position
Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
Responsibilities
ā¢ Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
ā¢ Facilitates comprehensive waiver enrollment and disenrollment processes.
ā¢ Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals.
ā¢ Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
ā¢ Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care.
ā¢ Assesses for medical necessity and authorizes all appropriate waiver services.
ā¢ Evaluates covered benefits and advises appropriately regarding funding sources.
ā¢ Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration.
ā¢ Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
ā¢ Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns.
ā¢ Identifies critical incidents and develops prevention plans to assure member health and welfare.
ā¢ Collaborates with licensed care managers/leadership as needed or required.
ā¢ 25-40% estimated local travel may be required (based upon state/contractual requirements).
Requirements
ā¢ At least 2 years health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.
ā¢ Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
ā¢ In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).
ā¢ Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
ā¢ Demonstrated knowledge of community resources.
ā¢ Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
ā¢ Ability to operate proactively and demonstrate detail-oriented work.
ā¢ Ability to work independently, with minimal supervision and self-motivation.
ā¢ Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations.
ā¢ Ability to develop and maintain professional relationships.
ā¢ Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
ā¢ Excellent problem-solving, and critical-thinking skills.
ā¢ Strong verbal and written communication skills.
ā¢ Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
ā¢ In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).
Nice-to-haves
ā¢ Certified Case Manager (CCM), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice.
ā¢ Experience working with populations that receive waiver services.
Benefits
ā¢ Molina Healthcare offers a competitive benefits and compensation package.
Apply Now
Apply Now
Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
Responsibilities
ā¢ Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
ā¢ Facilitates comprehensive waiver enrollment and disenrollment processes.
ā¢ Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals.
ā¢ Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
ā¢ Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care.
ā¢ Assesses for medical necessity and authorizes all appropriate waiver services.
ā¢ Evaluates covered benefits and advises appropriately regarding funding sources.
ā¢ Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration.
ā¢ Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
ā¢ Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns.
ā¢ Identifies critical incidents and develops prevention plans to assure member health and welfare.
ā¢ Collaborates with licensed care managers/leadership as needed or required.
ā¢ 25-40% estimated local travel may be required (based upon state/contractual requirements).
Requirements
ā¢ At least 2 years health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.
ā¢ Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
ā¢ In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).
ā¢ Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
ā¢ Demonstrated knowledge of community resources.
ā¢ Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
ā¢ Ability to operate proactively and demonstrate detail-oriented work.
ā¢ Ability to work independently, with minimal supervision and self-motivation.
ā¢ Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations.
ā¢ Ability to develop and maintain professional relationships.
ā¢ Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
ā¢ Excellent problem-solving, and critical-thinking skills.
ā¢ Strong verbal and written communication skills.
ā¢ Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
ā¢ In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).
Nice-to-haves
ā¢ Certified Case Manager (CCM), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice.
ā¢ Experience working with populations that receive waiver services.
Benefits
ā¢ Molina Healthcare offers a competitive benefits and compensation package.
Apply Now
Apply Now