Case Manager, LTSS - Field travel in Dane County, WI

$97,365 - $97,365/Yr

Molina Healthcare - Madison, WI

Full-time - Mid Level

Madison, WI

251-500 employees

Insurance Carriers and Related Activities

About the position

As a Case Manager at Molina Healthcare, you will be responsible for assessing, facilitating, planning, and coordinating integrated care delivery for members with high needs, including behavioral health and long-term care. This role involves working closely with members, providers, and multidisciplinary teams to ensure quality care that is both medically appropriate and cost-effective. You will engage in face-to-face assessments, develop care plans, and monitor progress to enhance the continuity of care for Molina members.

Responsibilities

• Complete face-to-face comprehensive assessments of members per regulated timelines.
• Facilitate comprehensive waiver enrollment and disenrollment processes.
• Develop and implement a case management plan in collaboration with the member, caregiver, physician, and other healthcare professionals.
• Perform ongoing monitoring of the care plan to evaluate effectiveness and suggest changes as needed.
• Promote integration of services for members, including behavioral health care and long-term services and supports.
• Assess for medical necessity and authorize appropriate waiver services.
• Evaluate covered benefits and advise on funding sources.
• Conduct face-to-face or home visits as required.
• Facilitate interdisciplinary care team meetings for service approval or denial.
• Use motivational interviewing to educate and support members during contacts.
• Assess for barriers to care and provide coordination to address obstacles.
• Identify critical incidents and develop prevention plans.

Requirements

• Bachelor's or master's degree in a social science, psychology, gerontology, public health, or social work.
• 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/behavioral health settings.

Nice-to-haves

• 3-5 years in case management, disease management, managed care, or medical/behavioral health settings.
• 1 year experience working with populations receiving waiver services.
• Active and unrestricted Certified Case Manager (CCM) certification.
• Clinical Social Worker license in good standing.

Benefits

• Medical, Dental, and Vision Insurance
• Group & Voluntary Life Insurance
• Aflac, Pet Health, and Identity Theft Insurance
• Flexible Spending Accounts
• 401K and Roth 401K
• Employee Stock Purchase Plan
• Continuing Education Units
• Education Reimbursement
• Paid Time Off
• Volunteer Time Off
• Company Holidays
• Legal Assistance Plan
• Employee Assistance & Well Being Programs
• Employee Perks Platform
• Rideshare Portal