Case Manager III

Job Title

Responsible for health care management and coordination of Molina Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes.

Essential Functions:

• Provides case management services to members with chronic or complex conditions including:
• Proactively identifies members that may qualify for potential case management services.
• 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.
• Identifies, assesses and manages members per established criteria.
• 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.
• Performs ongoing monitoring of the plan of care to evaluate effectiveness.
• Documents care plan progress in Molina's information system.
• Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
• 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.
• 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.

Knowledge/Skills/Abilities:

• Demonstrated ability to communicate, problem solve, and work effectively with people.
• 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.
• 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.

Required Education: Bachelor's degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree).

Required Experience: 5-7 years of clinical experience with case management experience.

Required Licensure/Certification: Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing. A combination of experience and education will be considered in lieu of LCSW or APSW. Must have valid driver's license with good driving record and be able to drive locally.