Job Summary
Provides support for care management/care coordination long‑term services and supports, collaborating with a multidisciplinary team to coordinate integrated delivery of member care across the continuum for high‑need members. Strives to ensure member progress toward desired outcomes and contributes to the 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 other healthcare professionals.
Performs ongoing monitoring of the 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 LTSS, and home and community resources to enhance continuity of care.
Assesses 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 barriers to care and provides care coordination to address psycho/social, financial, and medical obstacles.
Identifies critical incidents and develops prevention plans to assure member health and welfare.
Collaborates with licensed care managers/leadership as needed.
25‑40% local travel may be required based on state/contractual requirements.
Required Qualifications
At least 2 years of healthcare experience, including at least 1 year with persons with disabilities/chronic conditions in LTSS, and 1 year in care management or a medical/behavioral health setting.
LPN or LVN license or applicable clinical licensure/certification (active and unrestricted) if required by state contract.
Valid, unrestricted driver’s license with reliable transportation and adequate auto insurance.
Demonstrated knowledge of community resources.
Ability to work within diverse settings and adapt communication style.
Detail‑oriented, self‑motivated, and able to work independently with minimal supervision.
Excellent communication and time‑management skills; ability to prioritize and adapt to change.
Strong problem‑solving and critical‑thinking abilities.
Proficiency in Microsoft Office, online portals, and databases.
Preferred Qualifications
Certified Case Manager (CCM), LVN, or LPN with active, unrestricted state license.
Experience working with populations that receive waiver services.
Pay Range: $25.20 – $49.15 / hourly
Pay information may vary based on location, experience, and qualifications.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.