JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. 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.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• 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 long-term services and supports, home and community to enhance the continuity of care for Molina members.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

• Conducts face-to-face or home visits as required.

• Facilitates interdisciplinary care team 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, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member’s health and welfare.

• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or master’s degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background

REQUIRED EXPERIENCE:

• 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.

PREFERRED EXPERIENCE:

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

• 1 year experience working with population who receive waiver services.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing

Valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation

STATE SPECIFIC REQUIREMENTS:

For the state of Wisconsin:

Bachelor’s degree or more advanced degree in the human services area and a minimum of one (1) year experience working with at least one of the Family Care target populations; or

Bachelor’s degree or more advanced degree in any area other than human services with a minimum of three (3) years’ experience working with at least one of the Family Care target populations.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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.