What are the responsibilities and job description for the Care Manager, LTSS position at Molina Healthcare?
Family Care with My Choice Wisconsin
Job Summary:
Molina Healthcare Services (HCS) works with members, providers, and a multidisciplinary team to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum for members with high need potential.
Care Coordination:
HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
Key Responsibilities:
- Complete face-to-face comprehensive assessments of members per regulated timelines.
- Facilitate waiver enrollment and disenrollment processes.
- Develop and implement a case management plan in collaboration with the member, caregiver, physician, and/or other healthcare professionals.
- Perform ongoing monitoring of the care plan to evaluate effectiveness and suggest changes accordingly.
- Promote integration of services for members including behavioral health care and long-term services and supports.
- Assess for medical necessity and authorize all appropriate waiver services.
- Evaluate covered benefits and advise regarding funding source.
- Conduct face-to-face or home visits as required.
- Facilitate interdisciplinary care team meetings and informal collaboration.
- Use motivational interviewing and Molina clinical guideposts to educate and motivate change during member contacts.
- Identify barriers to care and provide assistance to address psycho/social, financial, and medical obstacles.
Education and Experience:
- Bachelor's or master's degree in a social science, psychology, gerontology, public health, or social work.
- At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports.
- 1-3 years in case management, disease management, managed care, or medical or behavioral health settings.
Licensure and Certification:
- Active and unrestricted Certified Case Manager (CCM).
- Active, unrestricted Clinical Social Worker license in good standing.
- Valid driver's license with a good driving record.
State Specific Requirements:
In Wisconsin: Bachelor's degree in human services or more advanced degree with at least 1 year of experience working with Family Care target populations, or a bachelor's degree in any area with at least 3 years of experience.