Iowa Case Manager, LTSS

$97,365 - $97,365/Yr

Molina Healthcare - Des Moines, IA

Full-time

Des Moines, IA

Insurance Carriers and Related Activities

About the position

The position involves working with Molina Healthcare Services to assess, facilitate, plan, and coordinate integrated care delivery for members with high need potential. The role focuses on ensuring quality care that is medically appropriate and cost-effective, while promoting the integration of services including behavioral health and long-term care.

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 accordingly.
• Promote integration of services for members including behavioral health care and long-term services and supports.
• Assess for medical necessity and authorize all appropriate waiver services.
• Evaluate covered benefits and advise appropriately regarding funding sources.
• Conduct face-to-face or home visits as required.
• Facilitate interdisciplinary care team meetings for approval or denial of services.
• Use motivational interviewing to educate and support members during contacts.
• Assess for barriers to care and provide care coordination to address obstacles.
• Identify critical incidents and develop prevention plans to assure member's health and welfare.

Requirements

• Completion of an accredited Licensed Registered Nurse (RN) Program or a Bachelor's or Master's degree in a relevant field.
• 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 who receive waiver services.
• Active and unrestricted Certified Case Manager (CCM) certification.
• Active, unrestricted State Nursing license (LVN/LPN/RN) or Clinical Social Worker license in good standing.

Benefits

• Competitive benefits and compensation package.