JOB DESCRIPTION Job Summary

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.

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.

– Collaborates with licensed care managers/leadership as needed or required.

– 25-40% estimated local travel may be required (based upon state/contractual requirements).

Required Qualifications

– 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.

-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.

– 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.

– Demonstrated knowledge of community resources.

– Ability to work within a variety of settings and adjust style as needed – working with diverse populations, various personalities and personal situations.

– Ability to operate proactively and demonstrate detail-oriented work.

– Ability to work independently, with minimal supervision and self-motivation.

– Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations.

– Ability to develop and maintain professional relationships.

– Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.

– Excellent problem-solving, and critical-thinking skills.

– Strong verbal and written communication skills.

– Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.

– In some states, a bachelor’s degree in a health care related field may be required (dependent upon state/contractual requirements).

**Preferred Qualifications**

– Certified Case Manager (CCM) preferred.

– Experience working with populations that receive waiver services.

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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

Pay Range: $22.8 – $46.81 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.