LTSS Care Manager

Quick Facts

• Role: LTSS Care Manager
• Work: Remote with local travel for member visits throughout Dane County, WI

Description

Provides LTSS-specific care management and care coordination to support members with high-need potential. Conducts regulated comprehensive assessments, facilitates waiver enrollment/disenrollment, develops and monitors care plans, and promotes integration of medical, behavioral health, and home/community resources. Collaborates with a multidisciplinary care team to help members progress toward desired outcomes with quality, cost-effective care.

Responsibilities

• Complete comprehensive member assessments within regulated timelines, including in-person home visits as required
• Facilitate comprehensive waiver enrollment and disenrollment processes
• Develop and implement care plans, including waiver service plans, with members, caregivers, physicians, and other health care professionals
• Perform ongoing monitoring of care plans to evaluate effectiveness, document interventions, and recommend changes
• Promote integration of services including behavioral health care and LTSS/home and community resources
• Assess for medical necessity and authorize appropriate waiver services
• Evaluate covered benefits and advise regarding funding sources
• Facilitate interdisciplinary care team (ICT) meetings for approval/denial of services and support informal ICT collaboration
• Use motivational interviewing and clinical guideposts to educate, support, and motivate change
• Assess barriers to care and provide care coordination for psycho/social, financial, and medical obstacles
• Identify critical incidents and develop prevention plans to assure member health and welfare
• Collaborate with licensed care managers/leadership as needed

Requirements

• At least 2 years of health care experience, including 1 year working with persons with disabilities/chronic conditions in LTSS
• At least 1 year of care management experience (or equivalent combination of relevant education and experience, or experience in medical/behavioral health settings)
• Clinical licensure/certification only if required by state contract/regulation/business model/state board mandates (must be active and unrestricted in state of practice if required)
• In some states, bachelor’s degree in a health care–related field may be required
• Valid and unrestricted driver’s license, reliable transportation, and adequate auto insurance for travel
• Demonstrated knowledge of community resources
• Ability to work independently with minimal supervision and self-motivation
• Strong verbal and written communication skills
• Ability to work in varied settings with diverse populations
• Proactive, detail-oriented work style; strong time management and prioritization; ability to handle multiple projects and adapt to change
• Problem-solving skills and ability to remain calm in high-pressure situations
• Ability to develop and maintain professional relationships
• Proficiency with Microsoft Office and ability to navigate online portals and databases
• In some states, at least 1 year of experience working directly with individuals with substance use disorders

Preferred Qualifications

• Certified Case Manager (CCM) or LVN/LPN (active and unrestricted in state of practice)
• Experience working with populations that receive waiver services

Benefits

• Competitive benefits and compensation package
• Equal Opportunity Employer (EOE)