Case Manager, LTSS : ILLINOIS

About the position

Molina Healthcare Services (HCS) is seeking a dedicated Nurse or Social Work Case Manager to join our team in Illinois. This remote-based position requires the candidate to live in Illinois and travel within specific counties, including Williamson, Alexander, Union, Johnson, Pope, Massac, Pulaski, Hardin, Jackson, Saline, and Gallatin. The role involves working closely with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate integrated care delivery across various services, including behavioral health and long-term care for members with high needs. The Case Manager will ensure that patients progress toward desired outcomes with quality care that is both medically appropriate and cost-effective, based on the severity of illness and the site of service. In this fast-paced environment, the Case Manager will be responsible for completing face-to-face comprehensive assessments of members, facilitating waiver enrollment processes, and developing and implementing case management plans in collaboration with members, caregivers, and healthcare professionals. Ongoing monitoring of care plans is essential to evaluate effectiveness, document interventions, and suggest necessary changes. The role also includes promoting the integration of services for members, assessing medical necessity, conducting home visits, and facilitating interdisciplinary care team meetings. The Case Manager will utilize motivational interviewing techniques to educate and support members, assess barriers to care, and provide necessary care coordination. Candidates must possess excellent computer skills and attention to detail, as the role requires multitasking between systems and maintaining accurate contact notes. A clean DMV driving record, proof of auto insurance, and reliable transportation are mandatory, as the position requires 50-75% travel for member visits. The successful candidate will have a strong background in case management, particularly with individuals with disabilities or chronic conditions, and will be committed to enhancing the continuity of care for Molina members.

Responsibilities
? Complete face-to-face comprehensive assessments of members per regulated timelines.
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? Facilitate comprehensive waiver enrollment and disenrollment processes.
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? Develop and implement a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician, and other healthcare professionals.
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? Perform ongoing monitoring of the care plan to evaluate effectiveness, document interventions, and suggest changes accordingly.
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? Promote integration of services for members including behavioral health care and long-term services and supports.
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? Assess for medical necessity and authorize all appropriate waiver services.
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? Evaluate covered benefits and advise appropriately regarding funding sources.
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? Conduct face-to-face or home visits as required.
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? Facilitate interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration.
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? Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate change during member contacts.
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? Assess for barriers to care and provide care coordination to address psycho/social, financial, and medical obstacles.
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? Identify critical incidents and develop prevention plans to assure member's health and welfare.
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? Provide consultation, recommendations, and education as appropriate to non-RN case managers.
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? Work with members who have complex medical conditions and medication regimens.
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? Conduct medication reconciliation when needed.

Requirements
? Graduate from an Accredited School of Nursing.
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? At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports.
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? 1-3 years in case management, disease management, managed care, or medical or behavioral health settings.
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? Active, unrestricted State Registered Nursing license (RN) in good standing.
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? Valid driver's license with good driving record and reliable transportation.

Nice-to-haves
? Bachelor's Degree in Nursing.
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? 3-5 years in case management, disease management, managed care, or medical or behavioral health settings.
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? 1 year experience working with a population who receive waiver services.
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? Active and unrestricted Certified Case Manager (CCM).

Benefits
? Competitive benefits and compensation package.
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? Mileage reimbursement for travel.

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