Field Care Manager, LTSS

About This Role

This role supports long-term services and supports (LTSS) care management activities, coordinating integrated delivery of member care for individuals with high-need potential. You will complete assessments, develop care plans, and ensure member progress toward desired outcomes.

Responsibilities

• Complete comprehensive member assessments within regulated timelines, including in-person home visits as required
• Facilitate comprehensive waiver enrollment and disenrollment processes
• Develop and implement care plans, including a waiver service plan in collaboration with members, caregivers, physicians and other appropriate health care professionals and member support network to address the member needs and goals
• Perform ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly
• Promote 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
• Assess for medical necessity and authorize all appropriate waiver services
• Evaluate covered benefits and advise appropriately regarding funding sources
• Facilitate interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration
• Use motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts
• Assess for barriers to care and provide care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns

Requirements

• 2+ years healthcare experience
• 1+ year experience working with persons with disabilities/chronic conditions (LTSS)
• 1+ year experience in care management or medical/behavioral health setting
• Current LPN or LVN license (if required by state contract/regulation)
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance
• Demonstrated knowledge of community resources
• Proficiency with Microsoft Office suite and ability to navigate online portals and databases

Qualifications

• Bachelor's degree in a health care related field (may be required in some states)
• At least 2 years healthcare experience, including at least 1 year with persons with disabilities/chronic conditions (LTSS) and 1 year in care management, or equivalent combination of relevant education and experience

Nice to Have

• Certified Case Manager (CCM)
• Experience working with populations that receive waiver services

Skills

* Required skills

Benefits