Case Mgr I (3204BR) Independence, Ohio
o Proactively identifies members that may qualify for potential case management services.
o Conducts assessment of member needs by collecting in-depth information from Molina’s information system, the member, member’s family/caregiver, hospital staff, physicians and other providers.
o Identifies, assesses and manages members per established criteria.
o Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
o Performs ongoing monitoring of the plan of care to evaluate effectiveness.
o Documents care plan progress in Molina’s information system.
o Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
o Measures the effectiveness of interventions to determine case management outcomes.
• Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Molina members.
• Conducts face to face or home visits as required.
• Maintains department productivity and quality measures.
• Manages and completes assigned work plan objectives and projects in a timely manner.
• Demonstrates dependability and reliability.
• Maintains effective team member relations.
• Adheres to all documentation guidelines activities.
• Attends regular staff meetings.
• Participates in Interdisciplinary Care Team (ICT) meetings.
• Assists orientation and mentoring of new team members as appropriate.
• Maintains professional relationships with provider community and internal and external customers.
• Conducts self in a professional manner at all times.
• Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
• Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth.
• Complies with required workplace safety standards.
• Excellent organizational skill with the ability to manage multiple priorities.
• Work independently and handle multiple projects simultaneously.
• Strong analytical skills.
• Knowledge of applicable state, and federal regulations.
• Knowledge of ICD-9, CPT coding and HCPC. * for Behavioral Health focused CM knowledge of DSM IV TR and DSM 5 diagnostic coding
• Knowledge of SSI, Coordination of benefits, and Third Party Liability programs and integration.
• Familiarity with NCQA standards, state/federal regulations and measurement techniques.
• In depth knowledge of CCA and/or other Case Management tools.
• Ability to take initiative and see tasks to completion.
• Computer skills and experience with Microsoft Office Products.
• Excellent verbal and written communication skills.
• Ability to abide by Molina’s policies.
• Able to maintain regular attendance based upon agreed schedule.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.
Bachelor’s Degree in Social Work, Health Education or other mental/social health discipline (a combination of experience and education will be considered in lieu of degree).
Three or more years of clinical experience with two years or more Case Management experience
Must have valid driver’s license with good driving record and be able to drive locally.
Bachelor’s degree or Master’s degree in Health related field.
Three or more years of case management experience.
Case Management experience with a Medicaid/Medicare Population.
Certified Case Manager. (CCM), Certified Professional in Healthcare Management Certification (CPHM), Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification.
To all current Molina employees if you are interested in applying for this position please apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.
Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.