Care Manager, LTSS (Must Reside In Idaho)

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 and the member support network to address member needs and goals.
• Performs ongoing monitoring of care plans to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Promotes integration of services for members 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 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 psychosocial, financial, and medical obstacles or concerns.
• Identifies critical incidents and develops prevention plans to assure member health and welfare.
• Collaborates with licensed care managers/leadership as needed or required.
• May require 25-40% estimated local travel based on state/contractual requirements.

Required Qualifications

• At least 2 years of health care experience, including at least 1 year working with persons with disabilities/chronic conditions in long-term services and supports (LTSS), and 1 year in care management, 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 mandated by state contract, regulation, or state board licensing.
• 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 with diverse populations and various personalities.
• Ability to operate proactively and demonstrate detail orientation.
• Ability to work independently, with minimal supervision and self-motivation.
• Demonstrated responsiveness in all forms of communication and ability to remain calm in high-pressure situations.
• Proven ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills with the ability to manage multiple projects simultaneously and adapt to change.
• Strong problem-solving, critical-thinking, verbal, and written communication skills.
• Proficiency in Microsoft Office and applicable software, with the ability to navigate online portals and databases.

Preferred Qualifications

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

Benefits & Perks

• Salary: $24 - $56.17 / HOURLY
• Compensation: Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
• Benefits: Competitive benefits and compensation package.
• Schedule: Full Time