Care Manager, LTSS

Position Overview

Provides support for care management/care coordination long-term services and supports specific activities and collaborates with a 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.

Key Responsibilities

• 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.
• Performs ongoing monitoring of care plans to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Promotes integration of services including behavioral health care, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
• Assesses for medical necessity and authorizes appropriate waiver services while evaluating covered benefits and advising on funding sources.
• Facilitates interdisciplinary care team meetings for service approval or informal collaboration.
• Uses motivational interviewing and clinical guideposts to educate, support, and motivate change during member contacts.
• Assesses for barriers to care and provides care coordination to address psychosocial, 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.
• Local travel of 25-40% may be required based upon state/contractual requirements.

Required Qualifications

• At least 2 years of healthcare experience, including a minimum of 1 year working with persons with disabilities/chronic conditions in LTSS and 1 year in care management or a medical/behavioral health setting; or an equivalent combination of relevant education and experience.
• Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). Clinical licensure and/or certification is required if mandated by state contract, regulation, or board licensing; if licensed, the license must be active and unrestricted in the state of practice.
• In some states, a bachelor's degree in a healthcare-related field may be required based on state/contractual requirements.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job-related travel.
• Demonstrated knowledge of community resources.
• Ability to work in various settings with diverse populations and adjust style as needed.
• Proactive work ethic with strong attention to detail, independence, and self-motivation.
• Excellent time-management, prioritization, problem-solving, critical-thinking, and communication skills.
• Proficiency with Microsoft Office and applicable software, with the ability to navigate online portals and databases.
• Ability to develop and maintain professional relationships and remain responsive in all forms of communication, even in high-pressure situations.

Preferred Qualifications

• Certified Case Manager (CCM), Licensed Vocational Nurse (LVN), or Licensed Practical Nurse (LPN) with an active and unrestricted license in the state of practice.
• Experience working with populations that receive waiver services.

Benefits & Perks

• Compensation: Pay Range: $25.2 - $56.17 / HOURLY. Actual compensation may vary based on geographic location, work experience, education, and/or skill level.
• Employment Type: Full Time.
• Molina Healthcare offers a competitive benefits and compensation package.
• Equal Opportunity Employer (M/F/D/V).