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Assess patient health problems and needs, develop and implement nursing care plans, and maintain medical records. Administer nursing care to ill, injured, convalescent, or disabled patients.

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LTSS Service Care Manager

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  • Business Area: Clinical & Care Management
  • Job Type: Full time
  • Date Posted: Aug 08 2024
  • Job Number: 1512866

Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

THIS POSITION WILL BE SUPPORTING PENNSYLVANIA MEDICAID LTSS NURSING HOME TRANSITION PARTICIPANTS IN MONTGOMERY, BUCKS, PHILADELPHIA, CHESTER AND DELAWARE COUNTIES.

APPLICANTS WILL NEED TO RESIDE IN ONE OF THESE COUNTIES AND BE ABLE TO TRAVEL 50% OF THE TIME MONDAY - FRIDAY 8A - 5P. MILEAGE WILL BE REIMBURSED AT THE CURRENT IRS GUIDELINE RATE ROUND TRIP.

Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs.

  • Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome
  • Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialist, and/or community resources needed for long-term care
  • Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members
  • Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans
  • Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs
  • Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met
  • Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
  • May perform home and/or other site visits to assess member’s needs and collaborate with healthcare providers and partners
  • Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits
  • Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
  • Performs other duties as assigned
  • Complies with all policies and standards

Education/Experience: Requires a Bachelor's degree and 2 – 4 years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

License/Certification:

  • Valid state driver's license is required.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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What Minnesota Voters Think of Tim Walz

The governor succeeded in projecting an avuncular image. But not all voters are convinced that he rose above partisanship or united the state.

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Harris and Walz Hold First Campaign Rally Together

Vice president kamala harris and her newly announced running mate, gov. tim walz of minnesota, went on the attack against the trump-vance republican ticket during a raucous rally in philadelphia..

“To his former high school students, he was Mr. Walz. And to his former high school football players, he was Coach. And in 91 days, the nation will know Coach Walz by another name: Vice President of the United States.” “Thank you, Madam Vice President, for the trust you put in me, but maybe more so, thank you for bringing back the joy. Now, Donald Trump sees the world a little differently than us. First of all, he doesn’t know the first thing about service. He doesn’t have time for it because he’s too busy serving himself. Like all regular people I grew up with in the heartland, JD [Vance] studied at Yale, had his career funded by Silicon Valley billionaires, and then wrote a best seller trashing that community. Come on. That’s not what middle America is. And I got to tell you, I can’t wait to debate the guy.”

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By Robb Murray Christina Capecchi Dan Simmons Jeff Ernst and Richard Fausset

Robb Murray, Christina Capecchi, Dan Simmons and Jeff Ernst reported from throughout Minnesota. Richard Fausset contributed from Atlanta.

If Gov. Tim Walz has achieved anything after 18 years in public office, it has been to convince many of his fellow Minnesotans that he is decidedly not weird.

On Tuesday, Annakeiko Reichel-Frink, a teacher from Mankato, Minn., called Mr. Walz “a very normal human being.” Maria Bevacqua, a college professor from the same small city, where Mr. Walz once taught at the high school, described him as “somebody you would bump into at the grocery store.” Adam Lueth, a college student who is leaning toward the Republican ticket, said that Mr. Walz, a Democrat, comes across as “a genuine guy.”

Mr. Walz was thrust into the national spotlight on Tuesday when Kamala Harris, the Democratic presidential nominee, announced that he would be her running mate. The second-term governor seemed to rocket to the top of the list after he used one word quite effectively against Donald Trump, the Republican candidate: He was simply being “weird.”

Mr. Walz has succeeded in projecting an avuncular, affable, relentlessly normcore image to Minnesotans. But on Tuesday, in interviews across the state, voters also seemed less than convinced that Governor Walz had succeeded in rising above partisanship, or in uniting the state as “One Minnesota,” as his 2018 campaign slogan put it.

That perceived lack of unity may partially be the result of Mr. Walz’s political formula, which has tended to serve up dollops of Minnesota nice over an ambitious progressive policy agenda, one that has its roots in Minnesota politicians like Hubert Humphrey or Walter Mondale.

But it may also be the case that a nice-guy candidate — even one whom voters could imagine having a beer with — has limited power to charm nowadays, when hot tempers and invective seem to be the rule.

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ATTENTION JOB SEEKERS AND MOLINA APPLICANTS: FRAUD ALERT

Be aware that third parties posing as Molina Healthcare may be soliciting money from job seekers and extending offers to candidates who have not interviewed. Molina does not engage in these type of practices. If you have received an offer and have not been engaging with Molina Healthcare in an interview process, reach out to [email protected] to validate the legitimacy of your offer. Please note that Molina has reported this activity to the appropriate law enforcement agencies for further investigation. If you feel you’ve been victimized, please report it to local law enforcement.

Care Review Clinician, Prior Authorization REMOTE LPN or LSW

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.

We are seeking a LPN or LSW candidate with UM and Inpatient Review experience. The Care Review Clinician must be able to work independently in a high-volume environment. Experience and knowledge of the NYS Medicaid guidelines is highly preferred. Further details to be discussed during our interview process.

Remote- requires LPN or LSW license

Work schedule Monday - Friday 8:30 AM to 5:00 PM EST with rotating weekend and holiday coverage- 2 hour shifts.

KNOWLEDGE/SKILLS/ABILITIES

  • Assesses 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 and eligibility for requested treatments and/or procedures.
  • Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
  • Processes requests within required timelines.
  • Refers appropriate prior authorization requests to Medical Directors.
  • 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

Any of the following:

Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR a bachelor’s or master’s degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only).

Required Experience

1-3 years of hospital or medical clinic experience.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in good standing OR a clinical license in good standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only).

LPN licensure

LSW licensure

Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.

Preferred Experience

3-5 years clinical practice with managed care, hospital nursing or utilization management experience.

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: $19.64 - $42.55 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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