Remote with travel throughout Pierce and St. Croix Counites, WI for member
visits
JOB DESCRIPTION
Job Summary
Provides support for care management/care coordination long-term services and
supports (LTSS)-specific activities. 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.
Essential Job Duties
• Completes comprehensive member assessments within regulated timelines,
including in-person home visits as required.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• 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.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document
interventions and goal achievement, and suggest changes accordingly.
• 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.
• Assesses for medical necessity and authorizes all appropriate waiver services.
• Evaluates covered benefits and advises appropriately regarding funding
sources.
• Facilitates interdisciplinary care team (ICT) meetings for approval or denial
of services and informal ICT collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate,
support and motivate change during member contacts.
• Assesses for barriers to care and provides care coordination and assistance to
members to address psycho/social, financial, and medical obstacles concerns.
• Identifies critical incidents and develops prevention plans to assure member
health and welfare.
• May provide consultation, resources and recommendations to peers as needed.
• Care manager RNs may be assigned complex member cases and medication regimens.
• Care manager RNs may conduct medication reconciliation as needed.
• 25-40% estimated local travel may be required (based upon state/contractual
requirements).
Required Qualifications
• At least 2 years of experience in health care, including at least 1 year
experience in care management, managed care, and/or experience in a medical or
behavioral health setting, and at least 1 year of experience working with
persons with disabilities, chronic conditions, substance abuse disorders, and
long-term services and supports (LTSS), or equivalent combination of relevant
education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of
practice.
• In some states, a bachelor's degree in a health care related field may be
required (dependent upon state/contractual requirements).
• Valid and unrestricted driver's license, reliable transportation, and adequate
auto insurance for job related travel requirements, unless otherwise required by
law.
• Ability to operate proactively and demonstrate detail-oriented work.
• Demonstrated knowledge of community resources.
• Ability to work within a variety of settings and adjust style as needed -
working with diverse populations and various personalities and personal
situations.
• Ability to work independently, with minimal supervision and demonstrate
self-motivation.
• Responsiveness in all forms of communication, and ability to remain calm in
high-pressure situations.
• Ability to develop and maintain professional relationships.
• Time-management and prioritization skills, and ability to focus on multiple
projects simultaneously and adapt to change.
• Problem-solving skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
• In some states, must have at least one year of experience working directly
with individuals with substance use disorders.
Preferred Qualifications
• Certified Case Manager (CCM).
• Experience working with populations that receive waiver services.
To all current Molina employees: If you are interested in applying for this
position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina
Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V