Company Detail

Job Description

JOB DESCRIPTION

Family Care with My Choice Wisconsin

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Promotes integration of services for members including behavioral health care and long-term services and supports, home and community to enhance the continuity of care for Molina members.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

• Conducts face-to-face or home visits as required.

• Facilitates interdisciplinary care team 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, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background

REQUIRED EXPERIENCE:

• 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 or behavioral health settings.

PREFERRED EXPERIENCE:

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

• 1 year experience working with population who receive waiver services.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing

Valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation

STATE SPECIFIC REQUIREMENTS:

For the state of Wisconsin:

Bachelor's degree or more advanced degree in the human services area and a minimum of one (1) year experience working with at least one of the Family Care target populations; or

Bachelor's degree or more advanced degree in any area other than human services with a minimum of three (3) years' experience working with at least one of the Family Care target populations.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJHS

Pay Range: $21.6 - $46.81 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long-term health care needs? Then TMG wants to hear from you!

We're currently looking for someone with a social services or human services background to join our team. This is a remote position, where you will partner with people in your community who are enrolled in the Wisconsin IRIS Program and the TMG IRIS Consultant Agency. While your office will be home-based, you will have regularly scheduled visits with IRIS participants in their home and community.

As an IRIS Consultant (IC), you will build relationships with the people you partner with and help them navigate and get the most out of the Wisconsin IRIS program - a Medicaid long-term care option for older adults and people with disabilities. You can learn more about the IRIS program on the Wisconsin Department of Health Services website here (https://dhs.wisconsin.gov/iris/index.htm) . Together, you will identify the long-term care goals of the people enrolled in IRIS, and find creative ways to achieve those goals.

ICs play an important role in helping people of various backgrounds and abilities live the lives that they choose. In fact, people constantly tell us how supportive our ICs are and what a positive impact our ICs have had on their lives! Successful candidates for this position will be compassionate, genuine, resourceful partners with an eye for high quality work, and who are excited to work side-by side with people enrolled in IRIS.

As an IC, you will connect people to the resources available in their community. You will also help them develop customized IRIS plans for achieving their goals related to employment, housing, health, safety, community membership, transportation, and lasting relationships. While you will have a routine for the work that you do, no two days are alike!

TMG wants to find the best possible candidates, so we created this Realistic Job Preview to provide you with an inside look at the position and our organization. Find out more about the IRIS Consultant position by clicking on the link (https://www.youtube.com/watch?v=2vCojx1dK3I) and then reviewing the job posting below.

TMG is committed to maintaining a diverse and inclusive workforce and prioritizes helping staff have a good work/life balance. Even though the position is remote, you'll have lots of support from your TMG team and coworkers across the organization. If this sounds like the job for you, apply today!

KNOWLEDGE/SKILLS/ABILITIES

• Required to meet in person with the IRIS participant a minimum of four times per year, with one required annual visit in the home of the participant. Because IRIS is a self-directed program, it is important for ICs to be available upon the request of the participant.

• Responsible for providing program orientation to new participants. During this time, participants will learn their rights and responsibilities as someone enrolled in the IRIS program, including verifying legal documents, completing employee paperwork and the responsible use of public dollars.

• Explore a broad view of the participant's life, including goals, important relationships, connections with the local community, interest in employment, awareness of the Self-Directed Personal Care option, and back-up support plans.

• Assist participants in identifying personal outcomes and ensure those outcomes are being met on an ongoing basis, all while staying within the participant's IRIS budget and within the requirements of the IRIS program determined by the Department of Health Services (DHS).

• Responsible for documenting all orientation and planning activities within the IRIS data system (WISITs) within 48 business hours of the visit with the participant.

• Research community resources and natural supports that will fit the individual outcomes for each participant and share that information with them as it becomes available.

• Responsible for documenting progress and changes as needed within the plan and the data system anytime a modification is requested by a participant.

• Budget Amendment or One-Time Expense paperwork may be required depending upon factors associated with the participant and their individual IRIS budget.

• Educate participants on how to read and interpret their monthly budget reports to ensure that participants operate within their budget. Being a liaison between the Fiscal Employer Agency and the IRIS Consultant Agency is also a large part of the position, which includes assisting participants with provider billing, seeking support brokers, tracking receipts, ensuring their workers are paid and mitigating areas of potential risk or conflicts of interest.

• Responsible to develop engaged and trusting relationships with participants and communicate program changes and compliance effectively.

• Responsible to maintain confidentiality and HIPPA compliance.

• Work collaboratively with other IRIS Consultant Agency staff in order to ensure a successful implementation of participants' plans.

• Attend in-person monthly team meetings with other ICs and their supervisor. In addition, weekly IC and IRIS Consultant Supervisor phone check-ins may occur, along with other duties as assigned.

JOB QUALIFICATIONS

Required Education

Bachelor's degree in a social work, psychology, human services, counseling, nursing, special education, or a closely related field (or four years of commensurate experience if no degree).

Required Experience

• 1+ year of direct experience related to the delivery of social services to the target groups (individuals with intellectual or physical disabilities and older adults).

• Ability to work independently, with minimal supervision and be self-motivated.

• Knowledge of Long-Term Care programs and familiarity with principles of self-determination.

• Excellent problem-solving skills, critical thinking skills and strong basic math skills.

• Excellent time management and prioritization skills to focus on multiple projects simultaneously and adapt to change.

• Ability to develop and maintain professional relationships and work through situations without taking it personally.

• Comfortable working within a variety of settings and adjust style as needed; to work with a diverse population, various personalities, and personal situations.

• Resourceful and have knowledge of community resources while being proactive and detail oriented.

• Ability to use a variety of technology including but not limited to, Outlook, Skype, Teams, PowerPoint, Excel, Word, online portals and databases.

Required License, Certification, Association

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJHS

Pay Range: $18.04 - $35.17 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Family Care with My Choice Wisconsin

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Promotes integration of services for members including behavioral health care and long-term services and supports, home and community to enhance the continuity of care for Molina members.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

• Conducts face-to-face or home visits as required.

• Facilitates interdisciplinary care team 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, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background

REQUIRED EXPERIENCE:

• 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 or behavioral health settings.

PREFERRED EXPERIENCE:

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

• 1 year experience working with population who receive waiver services.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing

Valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation

STATE SPECIFIC REQUIREMENTS:

For the state of Wisconsin:

Bachelor's degree or more advanced degree in the human services area and a minimum of one (1) year experience working with at least one of the Family Care target populations; or

Bachelor's degree or more advanced degree in any area other than human services with a minimum of three (3) years' experience working with at least one of the Family Care target populations.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJHS

Pay Range: $21.6 - $46.81 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Family Care with My Choice Wisconsin

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Promotes integration of services for members including behavioral health care and long-term services and supports, home and community to enhance the continuity of care for Molina members.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

• Conducts face-to-face or home visits as required.

• Facilitates interdisciplinary care team 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, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background

REQUIRED EXPERIENCE:

• 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 or behavioral health settings.

PREFERRED EXPERIENCE:

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

• 1 year experience working with population who receive waiver services.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing

Valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation

STATE SPECIFIC REQUIREMENTS:

For the state of Wisconsin:

Bachelor's degree or more advanced degree in the human services area and a minimum of one (1) year experience working with at least one of the Family Care target populations; or

Bachelor's degree or more advanced degree in any area other than human services with a minimum of three (3) years' experience working with at least one of the Family Care target populations.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJHS

Pay Range: $21.6 - $46.81 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Responsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved market areas to achieve stated revenue, profitability, and retention goals, while following ethical sales practices and adhering to established policies and procedures.

KNOWLEDGE/SKILLS/ABILITIES

• Develop sales strategies to procure sufficient number of referrals and other self-generated leads to meet sales targets through active participation in community events and targeted community outreach to group associations, community centers, senior centers, senior residences and other potential marketing sites.

• Generate leads from referrals and local-tactical research and prospecting.

• Work assigned (company generated) leads in a timely manner.

• Schedule individual meetings and group presentations from assigned/self-generated leads.

• Achieve/Exceed monthly sales targets.

• Conduct presentations with potential customers. Customize sales presentations and develop sales skills to increase effectiveness in establishing rapport, assessing individual needs, and communicating product features and differences.

• Enroll eligible individuals in Molina Medicare products accurately and thoroughly complete and submit required enrollment documentation, consistent with Medicare requirements and enrollment guidelines. Assist the prospect in completion of the enrollment application. Forward completed applications to appropriate administrative contact within 48 hours of sale.

• Ensure Medicare beneficiaries accurately understand the product choices available to them, the enrollment process (eligibility requirements, Medicare review/approval of their enrollment application, timing of ID card receipt, etc.) and the service contacts and process.

• Track all marketing and sales activities, as well as update and maintain sales prospects daily, weekly and monthly results in SalesForce.com.

• Work closely with network providers to identify and educate potential members; participate in provider promotional activities.

JOB QUALIFICATIONS

Required Education

High School diploma/GED

Required Experience

2+ years Medicare, Medicaid, managed care or other health/insurance related sales experience

Required License, Certification, Association

Active, unrestricted Life & Health (Disability) Agent license

Preferred Education

AA degree

Preferred Experience

Bi-lingual

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

#PJSales

#LI-AC1

Pay Range: $33,761.52 - $73,149.97 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Opportunity for a TX licensed RN to work as a Case Manager with our Medicaid members in a service delivery area that is to the west and south of Houston. Previous experience working with LTSS population at a managed care organization is highly preferred, but we will consider RNs with strong Home Health/Hospice experience. Hours are 8 AM - 5 PM, Monday through Friday, and we offer mileage reimbursement as part of our benefit package. Meeting with the members in their homes will be part of the responsibilities of this role.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, Teams, and One Note.

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

• Conducts face-to-face or home visits as required.

• Facilitates interdisciplinary care team 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, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• Provides consultation, recommendations and education as appropriate to non-RN case managers

• Works cases with members who have complex medical conditions and medication regimens

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

• 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 or behavioral health settings.

• Required License, Certification, Association

• Active, unrestricted State Registered Nursing license (RN) in good standing

• If field work is required, Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements

Virginia: Must have at least one year of experience working directly with individuals with Substance Use Disorders

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

• 1 year experience working with population who receive waiver services.

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $23.76 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Responsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved market areas to achieve stated revenue, profitability, and retention goals, while following ethical sales practices and adhering to established policies and procedures.

KNOWLEDGE/SKILLS/ABILITIES

• Develop sales strategies to procure sufficient number of referrals and other self-generated leads to meet sales targets through active participation in community events and targeted community outreach to group associations, community centers, senior centers, senior residences and other potential marketing sites.

• Generate leads from referrals and local-tactical research and prospecting.

• Work assigned (company generated) leads in a timely manner.

• Schedule individual meetings and group presentations from assigned/self-generated leads.

• Achieve/Exceed monthly sales targets.

• Conduct presentations with potential customers. Customize sales presentations and develop sales skills to increase effectiveness in establishing rapport, assessing individual needs, and communicating product features and differences.

• Enroll eligible individuals in Molina Medicare products accurately and thoroughly complete and submit required enrollment documentation, consistent with Medicare requirements and enrollment guidelines. Assist the prospect in completion of the enrollment application. Forward completed applications to appropriate administrative contact within 48 hours of sale.

• Ensure Medicare beneficiaries accurately understand the product choices available to them, the enrollment process (eligibility requirements, Medicare review/approval of their enrollment application, timing of ID card receipt, etc.) and the service contacts and process.

• Track all marketing and sales activities, as well as update and maintain sales prospects daily, weekly and monthly results in SalesForce.com.

• Work closely with network providers to identify and educate potential members; participate in provider promotional activities.

JOB QUALIFICATIONS

Required Education

High School diploma/GED

Required Experience

2+ years Medicare, Medicaid, managed care or other health/insurance related sales experience

Required License, Certification, Association

Active, unrestricted Life & Health (Disability) Agent license

Preferred Education

AA degree

Preferred Experience

Bi-lingual

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

#PJSales

#LI-AC1

Pay Range: $33,761.52 - $73,149.97 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Opportunity for a TX licensed RN to work as a Case Manager with our IDD members. Previous experience with this population is highly preferred. Hours are 8 AM - 5 PM, Monday through Friday and we offer mileage reimbursement as part of our benefit package. Meeting with the members in their homes will be part of the responsibilities of this role.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, Teams, and One Note.

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

• Conducts face-to-face or home visits as required.

• Facilitates interdisciplinary care team 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, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• Provides consultation, recommendations and education as appropriate to non-RN case managers

• Works cases with members who have complex medical conditions and medication regimens

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

• 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 or behavioral health settings.

• Required License, Certification, Association

• Active, unrestricted State Registered Nursing license (RN) in good standing

• If field work is required, Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements

Virginia: Must have at least one year of experience working directly with individuals with Substance Use Disorders

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

• 1 year experience working with population who receive waiver services.

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $23.76 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Responsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved market areas to achieve stated revenue, profitability, and retention goals, while following ethical sales practices and adhering to established policies and procedures.

KNOWLEDGE/SKILLS/ABILITIES

• Develop sales strategies to procure sufficient number of referrals and other self-generated leads to meet sales targets through active participation in community events and targeted community outreach to group associations, community centers, senior centers, senior residences and other potential marketing sites.

• Generate leads from referrals and local-tactical research and prospecting.

• Work assigned (company generated) leads in a timely manner.

• Schedule individual meetings and group presentations from assigned/self-generated leads.

• Achieve/Exceed monthly sales targets.

• Conduct presentations with potential customers. Customize sales presentations and develop sales skills to increase effectiveness in establishing rapport, assessing individual needs, and communicating product features and differences.

• Enroll eligible individuals in Molina Medicare products accurately and thoroughly complete and submit required enrollment documentation, consistent with Medicare requirements and enrollment guidelines. Assist the prospect in completion of the enrollment application. Forward completed applications to appropriate administrative contact within 48 hours of sale.

• Ensure Medicare beneficiaries accurately understand the product choices available to them, the enrollment process (eligibility requirements, Medicare review/approval of their enrollment application, timing of ID card receipt, etc.) and the service contacts and process.

• Track all marketing and sales activities, as well as update and maintain sales prospects daily, weekly and monthly results in SalesForce.com.

• Work closely with network providers to identify and educate potential members; participate in provider promotional activities.

JOB QUALIFICATIONS

Required Education

High School diploma/GED

Required Experience

2+ years Medicare, Medicaid, managed care or other health/insurance related sales experience

Required License, Certification, Association

Active, unrestricted Life & Health (Disability) Agent license

Preferred Education

AA degree

Preferred Experience

Bi-lingual

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

#PJSales

#LI-AC1

Pay Range: $33,761.52 - $73,149.97 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

Responsible for the development and maintenance of an effective and efficient broker channel for assigned geographical region. Work in collaboration with other Broker Channel Managers, Field Sales Managers, Directors, and AVPs as needed in assigned states. Develop a high functioning, high performing broker network which is strategically aligned with Molina's mission and values. Utilize a combination of recruitment, mentoring, education, and channel management techniques to ensure brokers meet assigned objectives and enrollment targets. Assume accountability for the broker networks contribution to Molina's enrollment, profitability, and retention goals. Additionally, ensure brokers follow CMS and State Guidelines, along with basic ethical sales practices and adhere to established policies, procedures and industry best practices. Responsible for assisting their channel in the design and implementation of provider and community based relationships and growth campaigns, and monitor and report on their results

Knowledge/Skills/Abilities

- Recruit new GA/Brokers who are skilled at selling to Molina's target populations

- In collaboration with Agencies/agents in assigned area implement marketing plan to maximize self generated leads

- Agencies who receive company generated leads that the agency complies with established processes and timelines.

- Actively participate in the development and implementation of GA/Broker trainings

- Assist with broker ride-along, trainings and evaluations

- Work on development and on-going overview of territory Marketing Plans with GAs/Brokers

- Assist in business development strategies

- Generate regular reports on each GA to determine CAP if needed or relationship ended

- Work as liaison between Molina and/or National Medicare Broker/FMO, Exchange GA, sales agents and other departments (i.e. Membership Accounting)

o Weekly submission reports, missing applications, fax errors etc.....

- Track weekly/monthly member and provider issues for trending and reporting to management

- Assist with GA/Broker meetings and ongoing trainings

- Assist with projects:

o Competitive benefit comparison

o Monthly activity submission review

o Assist with provider presentations

- Collaborate effectively with Community Engagement teams within assigned markets, and develop sales strategies to procure sufficient number of referrals and other self-generated leads to meet sales targets.

- Generate leads from referrals and local-tactical research and prospecting..

Job Qualifications

Required Education

BA Degree or related experience

Required Experience

- 4-7 years Medicare, Medicaid, managed care or other health/insurance related sales experience.

- Experienced in self-generating leads through local area marketing.

- Current relationships with centers of influence for Molina products (Medicare/Marketplace/Medicaid)

- Ability to be on the road 90-100% of the time in the local service area.

- Maintain a valid driver's license and acceptable driver's record. Computer skills - Proficient computer skills to access customer information, utilizing technology to effectively communicate with customers and coworkers.

Required License, Certification, Association

Life & Health (Disability) Agent license

Preferred Education

BA Degree in Business Management or Healthcare Management

Preferred Experience

Bi-lingual; membership in related service organizations

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJSales

#LI-AC1

Pay Range: $54,373.27 - $117,808.76 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Responsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved market areas to achieve stated revenue, profitability, and retention goals, while following ethical sales practices and adhering to established policies and procedures.

KNOWLEDGE/SKILLS/ABILITIES

• Develop sales strategies to procure sufficient number of referrals and other self-generated leads to meet sales targets through active participation in community events and targeted community outreach to group associations, community centers, senior centers, senior residences and other potential marketing sites.

• Generate leads from referrals and local-tactical research and prospecting.

• Work assigned (company generated) leads in a timely manner.

• Schedule individual meetings and group presentations from assigned/self-generated leads.

• Achieve/Exceed monthly sales targets.

• Conduct presentations with potential customers. Customize sales presentations and develop sales skills to increase effectiveness in establishing rapport, assessing individual needs, and communicating product features and differences.

• Enroll eligible individuals in Molina Medicare products accurately and thoroughly complete and submit required enrollment documentation, consistent with Medicare requirements and enrollment guidelines. Assist the prospect in completion of the enrollment application. Forward completed applications to appropriate administrative contact within 48 hours of sale.

• Ensure Medicare beneficiaries accurately understand the product choices available to them, the enrollment process (eligibility requirements, Medicare review/approval of their enrollment application, timing of ID card receipt, etc.) and the service contacts and process.

• Track all marketing and sales activities, as well as update and maintain sales prospects daily, weekly and monthly results in SalesForce.com.

• Work closely with network providers to identify and educate potential members; participate in provider promotional activities.

JOB QUALIFICATIONS

Required Education

High School diploma/GED

Required Experience

2+ years Medicare, Medicaid, managed care or other health/insurance related sales experience

Required License, Certification, Association

Active, unrestricted Life & Health (Disability) Agent license

Preferred Education

AA degree

Preferred Experience

Bi-lingual

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

#PJSales

#LI-AC1

Pay Range: $33,761.52 - $73,149.97 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

IRIS Consultants (IC) are home-based employee who partners with individuals enrolled in the IRIS program to identify their long-term care goals and find creative ways to achieve them. Role works in communities where IRIS self-directed long-term care is offered as an alternative to managed care under the Family Care program. This role is a steady, trusted partner, working side-by side with people enrolled in IRIS.

This role builds upon the resources available in the community to help individuals develop customized plans to achieve their goals related to employment, housing, health, safety, community membership, transportation, and lasting relationships.

KNOWLEDGE/SKILLS/ABILITIES

• Required to meet with the IRIS participant a minimum of four times per year, with one required annual visit in the home of the participant. Because IRIS is a self-directed program, it is important for ICs to be available upon the request of the participant.

• Responsible for providing program orientation to new participants at which time participants will learn their rights and responsibilities as someone enrolled in the program, including verifying legal documents, completing employee paperwork and the responsible use of public dollars.

• Explore a broad view of the participant's life, including goals, important relationships, connections with the local community, interest in employment, awareness of the Self-Directed Personal Care option, and back-up support plans.

• Assist participants in identifying personal outcomes and ensure those outcomes are being met on an ongoing basis, all while staying within the participant's IRIS budget and within the requirements of the IRIS program determined by the Department of Health Services (DHS).

• Responsible for documenting all orientation and planning activities within the IRIS data system (WISITs) within 48 business hours of the visit with the participant.

• Research community resources and natural supports that will fit the individual outcomes for each participant and share that information with them as it becomes available.

• Responsible for documenting progress and changes as needed within the plan and the data system anytime a modification is requested by a participant.

• Budget Amendment or One-Time Expense paperwork may be required depending upon factors associated with the participant and their individual IRIS budget.

• Educate participants on how to read and interpret their monthly budget reports to ensure that participants operate within their budget. Being a liaison between the Fiscal Employer Agency and the IRIS Consultant Agency is also a large part of the position, which includes assisting participants with provider billing, seeking support brokers, tracking receipts, ensuring their workers are paid and mitigating areas of potential risk or conflicts of interest.

• Responsible for relaying difficult messages to the participants they partner with. The topic of these messages varies from a directive from DHS regarding a programmatic change to informing a participant their budget has been reduced to discussing health and safety issues to reporting events such as critical incidents about abuse and neglect. Due to the sensitive nature of some of these messages, at all times, it is important to maintain the strictest confidentiality with all participant related information including HIPAA and other personal or organizational information.

• Work collaboratively with other IRIS Consultant Agency staff in order to ensure a successful implementation of participants' plans.

• Attend face-to-face monthly team meetings with other ICs and their supervisor. In addition, weekly IC and IRIS Consultant Supervisor phone check-ins may occur, along with other duties as assigned

JOB QUALIFICATIONS

Required Education

Bachelor's degree in a social work, psychology, human services, counseling, nursing, special education, or a closely related field (or four years of commensurate experience if no degree).

Required Experience

• 1+ year of direct experience related to the delivery of social services to the target groups (individuals with intellectual or physical disabilities and older adults).

• Ability to work independently, with minimal supervision and be self-motivated.

• Knowledge of Long-Term Care programs and familiarity with principles of self-determination.

• Excellent problem-solving skills, critical thinking skills and strong basic math skills.

• Excellent time management and prioritization skills to focus on multiple projects simultaneously and adapt to change.

• Ability to develop and maintain professional relationships and work through situations without taking it personally.

• Comfortable working within a variety of settings and adjust style as needed; to work with a diverse population, various personalities, and personal situations.

• Resourceful and have knowledge of community resources while being proactive and detail oriented.

• Ability to use a variety of technology including but not limited to, Outlook, Skype, Teams, PowerPoint, Excel, Word, online portals and databases.

Required License, Certification, Association

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJHS

Pay Range: $18.04 - $35.17 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid

Knowledge/Skills/Abilities

- Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing and resolving member complaints and communicating resolution to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements.

- Provides direct oversight, monitoring and training of local plans' provider dispute and appeals units to ensure adherence with Medicare standards and requirements related to non-contracted provider dispute/appeals processing.

- Establishes member and non-contracted provider grievance/dispute and appeals policies/procedures and updates annually or as directed by the Centers for Medicare and Medicaid Services.

- Trains grievance and appeals staff, customer/member services department, sales, UM and other departments within Molina Medicare and Medicaid on early recognition and timely routing of member complaints.

- Trains each state's provider dispute resolution unit on CMS standards and requirements, including the proper use of the Molina Provider Grievance and appeals system.

- Reviews and analyzes collective grievance and appeals data along with audit results on unit's performance; analyzes and interprets trends and prepares reports that identify root causes of member dissatisfaction; recommends and implements process improvements to achieve member/provider satisfaction or operational effectiveness/efficiencies which contribute to Molina Medicare's maximum STAR ratings..

Job Qualifications

Required Education

Associate's Degree or 4 years of Medicare grievance and appeals experience.

Required Experience

- 7 years experience in healthcare claims review and/or member appeals and grievance processing/resolution, including 2 years in a manager role.

- Experience reviewing all types of medical claims (e.g. HCFA 1500, Outpatient/Inpatient UB92, Universal Claims, Stop Loss, Surgery, Anesthesia, high dollar complicated claims, COB and DRG/RCC pricing).

2 years supervisory/management experience with appeals/grievance processing within a managed care setting.

Required License, Certification, Association

N/A

Preferred Education

Bachelor's Degree

Preferred Experience

N/A

Preferred License, Certification, Association

N/A

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $87,568.7 - $189,732.18 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities.

KNOWLEDGE/SKILLS/ABILITIES

The Specialist, Quality Interventions/ QI Compliance contributes to one or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance.

• Implements key quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., removing barriers to care); preparation for Quality Improvement Compliance surveys; and other federal and state required quality activities.

• Monitors and ensures that key quality activities are completed on time and accurately to present results to key departmental management and other Molina departments as needed.

• Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings and limitations of department interventions.

• Creates, manages, and/or compiles the required documentation to maintain critical quality improvement functions.

• Leads quality improvement activities, meetings, and discussions with and between other departments within the organization.

• Evaluates project/program activities and results to identify opportunities for improvement.

• Surfaces to Manager and Director any gaps in processes that may require remediation.

• Other tasks, duties, projects, and programs as assigned.

This position may require same day out of office travel approximately 0 - 50% of the time, depending upon location.

This position may require multiple day out of town overnight travel approximately 0 - 20% of the time, depending upon location.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and work experience.

Required Experience

• Min. 3 years' experience in healthcare with 1 year experience in health plan quality improvement, managed care, or equivalent experience.

• Demonstrated solid business writing experience.

• Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Preferred Education

Preferred field: Clinical Quality, Public Health or Healthcare.

Preferred Experience

1 year of experience in Medicare and in Medicaid.

Preferred License, Certification, Association

• Certified Professional in Health Quality (CPHQ)

• Nursing License (RN may be preferred for specific roles)

• Certified HEDIS Compliance Auditor (CHCA)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $19.64 - $42.55 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Opportunity for a TX licensed RN to work as a Case Manager with our Medicaid members in a service delivery area that is to the west and south of Houston. Previous experience working with LTSS population at a managed care organization is highly preferred, but we will consider RNs with strong Home Health/Hospice experience. Hours are 8 AM - 5 PM, Monday through Friday, and we offer mileage reimbursement as part of our benefit package. Meeting with the members in their homes will be part of the responsibilities of this role.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, Teams, and One Note.

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

• Conducts face-to-face or home visits as required.

• Facilitates interdisciplinary care team 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, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• Provides consultation, recommendations and education as appropriate to non-RN case managers

• Works cases with members who have complex medical conditions and medication regimens

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

• 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 or behavioral health settings.

• Required License, Certification, Association

• Active, unrestricted State Registered Nursing license (RN) in good standing

• If field work is required, Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements

Virginia: Must have at least one year of experience working directly with individuals with Substance Use Disorders

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

• 1 year experience working with population who receive waiver services.

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $23.76 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Opportunity for a TX licensed RN to work as a Case Manager with our Medicaid members in a service delivery area that is to the west and south of Houston. Previous experience working with LTSS population at a managed care organization is highly preferred, but we will consider RNs with strong Home Health/Hospice experience. Hours are 8 AM - 5 PM, Monday through Friday, and we offer mileage reimbursement as part of our benefit package. Meeting with the members in their homes will be part of the responsibilities of this role.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, Teams, and One Note.

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

• Conducts face-to-face or home visits as required.

• Facilitates interdisciplinary care team 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, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• Provides consultation, recommendations and education as appropriate to non-RN case managers

• Works cases with members who have complex medical conditions and medication regimens

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

• 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 or behavioral health settings.

• Required License, Certification, Association

• Active, unrestricted State Registered Nursing license (RN) in good standing

• If field work is required, Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements

Virginia: Must have at least one year of experience working directly with individuals with Substance Use Disorders

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

• 1 year experience working with population who receive waiver services.

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $23.76 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

IRIS Consultants (IC) are home-based employee who partners with individuals enrolled in the IRIS program to identify their long-term care goals and find creative ways to achieve them. Role works in communities where IRIS self-directed long-term care is offered as an alternative to managed care under the Family Care program. This role is a steady, trusted partner, working side-by side with people enrolled in IRIS.

This role builds upon the resources available in the community to help individuals develop customized plans to achieve their goals related to employment, housing, health, safety, community membership, transportation, and lasting relationships.

KNOWLEDGE/SKILLS/ABILITIES

• Required to meet with the IRIS participant a minimum of four times per year, with one required annual visit in the home of the participant. Because IRIS is a self-directed program, it is important for ICs to be available upon the request of the participant.

• Responsible for providing program orientation to new participants at which time participants will learn their rights and responsibilities as someone enrolled in the program, including verifying legal documents, completing employee paperwork and the responsible use of public dollars.

• Explore a broad view of the participant's life, including goals, important relationships, connections with the local community, interest in employment, awareness of the Self-Directed Personal Care option, and back-up support plans.

• Assist participants in identifying personal outcomes and ensure those outcomes are being met on an ongoing basis, all while staying within the participant's IRIS budget and within the requirements of the IRIS program determined by the Department of Health Services (DHS).

• Responsible for documenting all orientation and planning activities within the IRIS data system (WISITs) within 48 business hours of the visit with the participant.

• Research community resources and natural supports that will fit the individual outcomes for each participant and share that information with them as it becomes available.

• Responsible for documenting progress and changes as needed within the plan and the data system anytime a modification is requested by a participant.

• Budget Amendment or One-Time Expense paperwork may be required depending upon factors associated with the participant and their individual IRIS budget.

• Educate participants on how to read and interpret their monthly budget reports to ensure that participants operate within their budget. Being a liaison between the Fiscal Employer Agency and the IRIS Consultant Agency is also a large part of the position, which includes assisting participants with provider billing, seeking support brokers, tracking receipts, ensuring their workers are paid and mitigating areas of potential risk or conflicts of interest.

• Responsible for relaying difficult messages to the participants they partner with. The topic of these messages varies from a directive from DHS regarding a programmatic change to informing a participant their budget has been reduced to discussing health and safety issues to reporting events such as critical incidents about abuse and neglect. Due to the sensitive nature of some of these messages, at all times, it is important to maintain the strictest confidentiality with all participant related information including HIPAA and other personal or organizational information.

• Work collaboratively with other IRIS Consultant Agency staff in order to ensure a successful implementation of participants' plans.

• Attend face-to-face monthly team meetings with other ICs and their supervisor. In addition, weekly IC and IRIS Consultant Supervisor phone check-ins may occur, along with other duties as assigned

JOB QUALIFICATIONS

Required Education

Bachelor's degree in a social work, psychology, human services, counseling, nursing, special education, or a closely related field (or four years of commensurate experience if no degree).

Required Experience

• 1+ year of direct experience related to the delivery of social services to the target groups (individuals with intellectual or physical disabilities and older adults).

• Ability to work independently, with minimal supervision and be self-motivated.

• Knowledge of Long-Term Care programs and familiarity with principles of self-determination.

• Excellent problem-solving skills, critical thinking skills and strong basic math skills.

• Excellent time management and prioritization skills to focus on multiple projects simultaneously and adapt to change.

• Ability to develop and maintain professional relationships and work through situations without taking it personally.

• Comfortable working within a variety of settings and adjust style as needed; to work with a diverse population, various personalities, and personal situations.

• Resourceful and have knowledge of community resources while being proactive and detail oriented.

• Ability to use a variety of technology including but not limited to, Outlook, Skype, Teams, PowerPoint, Excel, Word, online portals and databases.

Required License, Certification, Association

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJHS

Pay Range: $18.04 - $35.17 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Job Summary

IRIS Consultants (IC) are home-based employee who partners with individuals enrolled in the IRIS program to identify their long-term care goals and find creative ways to achieve them. Role works in communities where IRIS self-directed long-term care is offered as an alternative to managed care under the Family Care program. This role is a steady, trusted partner, working side-by side with people enrolled in IRIS.

This role builds upon the resources available in the community to help individuals develop customized plans to achieve their goals related to employment, housing, health, safety, community membership, transportation, and lasting relationships.

KNOWLEDGE/SKILLS/ABILITIES

• Required to meet with the IRIS participant a minimum of four times per year, with one required annual visit in the home of the participant. Because IRIS is a self-directed program, it is important for ICs to be available upon the request of the participant.

• Responsible for providing program orientation to new participants at which time participants will learn their rights and responsibilities as someone enrolled in the program, including verifying legal documents, completing employee paperwork and the responsible use of public dollars.

• Explore a broad view of the participant's life, including goals, important relationships, connections with the local community, interest in employment, awareness of the Self-Directed Personal Care option, and back-up support plans.

• Assist participants in identifying personal outcomes and ensure those outcomes are being met on an ongoing basis, all while staying within the participant's IRIS budget and within the requirements of the IRIS program determined by the Department of Health Services (DHS).

• Responsible for documenting all orientation and planning activities within the IRIS data system (WISITs) within 48 business hours of the visit with the participant.

• Research community resources and natural supports that will fit the individual outcomes for each participant and share that information with them as it becomes available.

• Responsible for documenting progress and changes as needed within the plan and the data system anytime a modification is requested by a participant.

• Budget Amendment or One-Time Expense paperwork may be required depending upon factors associated with the participant and their individual IRIS budget.

• Educate participants on how to read and interpret their monthly budget reports to ensure that participants operate within their budget. Being a liaison between the Fiscal Employer Agency and the IRIS Consultant Agency is also a large part of the position, which includes assisting participants with provider billing, seeking support brokers, tracking receipts, ensuring their workers are paid and mitigating areas of potential risk or conflicts of interest.

• Responsible for relaying difficult messages to the participants they partner with. The topic of these messages varies from a directive from DHS regarding a programmatic change to informing a participant their budget has been reduced to discussing health and safety issues to reporting events such as critical incidents about abuse and neglect. Due to the sensitive nature of some of these messages, at all times, it is important to maintain the strictest confidentiality with all participant related information including HIPAA and other personal or organizational information.

• Work collaboratively with other IRIS Consultant Agency staff in order to ensure a successful implementation of participants' plans.

• Attend face-to-face monthly team meetings with other ICs and their supervisor. In addition, weekly IC and IRIS Consultant Supervisor phone check-ins may occur, along with other duties as assigned

JOB QUALIFICATIONS

Required Education

Bachelor's degree in a social work, psychology, human services, counseling, nursing, special education, or a closely related field (or four years of commensurate experience if no degree).

Required Experience

• 1+ year of direct experience related to the delivery of social services to the target groups (individuals with intellectual or physical disabilities and older adults).

• Ability to work independently, with minimal supervision and be self-motivated.

• Knowledge of Long-Term Care programs and familiarity with principles of self-determination.

• Excellent problem-solving skills, critical thinking skills and strong basic math skills.

• Excellent time management and prioritization skills to focus on multiple projects simultaneously and adapt to change.

• Ability to develop and maintain professional relationships and work through situations without taking it personally.

• Comfortable working within a variety of settings and adjust style as needed; to work with a diverse population, various personalities, and personal situations.

• Resourceful and have knowledge of community resources while being proactive and detail oriented.

• Ability to use a variety of technology including but not limited to, Outlook, Skype, Teams, PowerPoint, Excel, Word, online portals and databases.

Required License, Certification, Association

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJHS

Pay Range: $18.04 - $35.17 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Opportunity for a TX licensed RN to work as a Case Manager with our Medicaid members in a service delivery area that is to the west and south of Houston. Previous experience working with LTSS population at a managed care organization is highly preferred, but we will consider RNs with strong Home Health/Hospice experience. Hours are 8 AM - 5 PM, Monday through Friday, and we offer mileage reimbursement as part of our benefit package. Meeting with the members in their homes will be part of the responsibilities of this role.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, Teams, and One Note.

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

• Conducts face-to-face or home visits as required.

• Facilitates interdisciplinary care team 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, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• Provides consultation, recommendations and education as appropriate to non-RN case managers

• Works cases with members who have complex medical conditions and medication regimens

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

• 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 or behavioral health settings.

• Required License, Certification, Association

• Active, unrestricted State Registered Nursing license (RN) in good standing

• If field work is required, Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements

Virginia: Must have at least one year of experience working directly with individuals with Substance Use Disorders

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

• 1 year experience working with population who receive waiver services.

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $23.76 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Family Care with My Choice Wisconsin

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Promotes integration of services for members including behavioral health care and long-term services and supports, home and community to enhance the continuity of care for Molina members.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

• Conducts face-to-face or home visits as required.

• Facilitates interdisciplinary care team 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, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background

REQUIRED EXPERIENCE:

• 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 or behavioral health settings.

PREFERRED EXPERIENCE:

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

• 1 year experience working with population who receive waiver services.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing

Valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation

STATE SPECIFIC REQUIREMENTS:

For the state of Wisconsin:

Bachelor's degree or more advanced degree in the human services area and a minimum of one (1) year experience working with at least one of the Family Care target populations; or

Bachelor's degree or more advanced degree in any area other than human services with a minimum of three (3) years' experience working with at least one of the Family Care target populations.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJHS

Pay Range: $21.6 - $46.81 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

Job Description

Job Summary

TMG is on the lookout for our next great Eligibility Screener! If you love doing meaningful work that helps others live their best lives, we want to hear from you!

We're currently in search for someone with a background in human services, social work, healthcare or case management to join our team. This is a remote position, where you will partner with people in your community who use the TMG IRIS Consultant Agency. While this role is home-based, you will spend most days visiting IRIS participants in their homes. While you'll have a routine for the work that you do, no two days are alike!

As an Eligibility Screener, you would be responsible for completing the Adult Long-Term Care Functional Screens (LTC-FS) for participants of the Wisconsin IRIS program - a Medicaid long-term care option for older adults and people with disabilities. The job includes completing annual rescreens and any change-in-condition screens using the Adult LTC-FS tool to ensure program eligibility. Successful candidates will be approachable, compassionate and respectful of people of all different backgrounds and abilities, and be able to see and articulate the strengths that people inherently have.

TMG is committed to maintaining a diverse and inclusive workforce, and prioritizes helping staff have a good work/life balance. Even though the position is remote, you'll have lots of support from your TMG team and coworkers across the organization. If this sounds like the job for you, apply today!

Job Duties

• Meets with IRIS participants face to face to complete the screening process.

• Completes the Adult Long Term Care Functional Screen (LTC-FS) for people in IRIS according to the Wisconsin Adult LTC-FS Instructions.

• Completes contacts to verify screen results with IRIS Consultants, Medicaid Personal Care agencies, and verifies diagnosis information with physicians and the Social Security Administration, when needed.

• Meets the highest standards of documentation and program regulations, while ensuring timely completion of screens.

• Maintains screening skills by participating in weekly team meetings, monthly All Screener Meetings, trainings and testing.

• Other duties as assigned by management.

Job Qualifications

REQUIRED EDUCATION :

Bachelor's Degree in a health or human services or related field. (e.g., social work, psychology) or graduate from an Accredited School of Nursing.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

• 1+ years of experience working with one of the target groups such as adults with physical or intellectual disabilities or older adults.

• Strong written and verbal communication skills; strong attention to detail.

• Demonstrated computer and software skills required; proficiency with Microsoft Office Suite and other software.

• Strong customer service skills.

• Good organizational and time management skills.

• The ability to work cooperatively as part of a team or autonomously

• Ability to remain flexible in the work environment and willing and able to adapt to changing organizational needs.

• Travel Requirements 5%

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION :

• Must pass the Wisconsin Adult Long-term Care Functional Screen certification modules (80% or higher on each module) within first week of hire and maintain certification as a screener.

• If a graduate from an Accredited School of Nursing, must have an active, unrestricted Wisconsin Registered Nursing (RN) license in good standing

• Must possess a valid driver's license, maintain adequate auto insurance for job-related travel and ability to travel throughout Wisconsin or other

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :

Currently or formerly certified in the Long-Term Care Functional Screen.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJHS

Pay Range: $19.84 - $38.69 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Opportunity for a TX licensed RN to work as a Case Manager with our Medicaid members in a service delivery area that is to the west and south of Houston. Previous experience working with LTSS population at a managed care organization is highly preferred, but we will consider RNs with strong Home Health/Hospice experience. Hours are 8 AM - 5 PM, Monday through Friday, and we offer mileage reimbursement as part of our benefit package. Meeting with the members in their homes will be part of the responsibilities of this role.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, Teams, and One Note.

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

• Conducts face-to-face or home visits as required.

• Facilitates interdisciplinary care team 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, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• Provides consultation, recommendations and education as appropriate to non-RN case managers

• Works cases with members who have complex medical conditions and medication regimens

• Conducts medication reconciliation when needed.

• 50-75% travel required.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

• 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 or behavioral health settings.

• Required License, Certification, Association

• Active, unrestricted State Registered Nursing license (RN) in good standing

• If field work is required, Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements

Virginia: Must have at least one year of experience working directly with individuals with Substance Use Disorders

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

• 1 year experience working with population who receive waiver services.

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $23.76 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Family Care with My Choice Wisconsin

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Promotes integration of services for members including behavioral health care and long-term services and supports, home and community to enhance the continuity of care for Molina members.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

• Conducts face-to-face or home visits as required.

• Facilitates interdisciplinary care team 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, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background

REQUIRED EXPERIENCE:

• 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 or behavioral health settings.

PREFERRED EXPERIENCE:

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

• 1 year experience working with population who receive waiver services.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing

Valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation

STATE SPECIFIC REQUIREMENTS:

For the state of Wisconsin:

Bachelor's degree or more advanced degree in the human services area and a minimum of one (1) year experience working with at least one of the Family Care target populations; or

Bachelor's degree or more advanced degree in any area other than human services with a minimum of three (3) years' experience working with at least one of the Family Care target populations.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJHS

Pay Range: $21.6 - $46.81 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

JOB DESCRIPTION

Family Care with My Choice Wisconsin

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Completes face-to-face comprehensive assessments of members per regulated timelines.

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• Promotes integration of services for members including behavioral health care and long-term services and supports, home and community to enhance the continuity of care for Molina members.

• Assesses for medical necessity and authorize all appropriate waiver services.

• Evaluates covered benefits and advise appropriately regarding funding source.

• Conducts face-to-face or home visits as required.

• Facilitates interdisciplinary care team 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, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.

• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

• 50-75% local travel required.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background

REQUIRED EXPERIENCE:

• 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 or behavioral health settings.

PREFERRED EXPERIENCE:

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

• 1 year experience working with population who receive waiver services.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Active and unrestricted Certified Case Manager (CCM)

Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing

Valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation

STATE SPECIFIC REQUIREMENTS:

For the state of Wisconsin:

Bachelor's degree or more advanced degree in the human services area and a minimum of one (1) year experience working with at least one of the Family Care target populations; or

Bachelor's degree or more advanced degree in any area other than human services with a minimum of three (3) years' experience working with at least one of the Family Care target populations.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJHS

Pay Range: $21.6 - $46.81 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare

Job Description

For this position we are seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. COMPACT / Multi state RN LICENSURE IS PREFERABLE to support multiple states.

Excellent computer skills and attention to detail are very important to multi task between systems, talk with members on the phone, and enter accurate contact notes. Virtual office skills are necessary to be collaborative between team members using MS Teams, videoconference, voice conferencing and email/ chat communications. This is a fast paced position and productivity is important. Home office with private desk area, and high speed internet connectivity required.

WORK HOURS: : 5 days / daytime work schedule 8:30AM to 5:30PM, some weekends and holidays.

This department operates 365 days a year and we need staff who can be flexible and willing to work some weekends and holidays. This is a remote position and you may work from home.

Further Details to be discussed during our interview process.

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.

• Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.

• Processes requests within required timelines.

• Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.

• Requests additional information from members or providers in consistent and efficient manner.

• Makes appropriate referrals to other clinical programs.

• Collaborates with multidisciplinary teams to promote Molina Care Model.

• Adheres to UM policies and procedures.

• Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Required Experience

3+ years hospital acute care/medical experience.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements:

IL Qualifications: Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

Recent hospital experience in ICU, Medical, or ER unit.

Preferred License, Certification, Association

Active, unrestricted Utilization Management Certification (CPHM).

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $23.76 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Detail

• Company:
  Molina Healthcare