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Molina Healthcare
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  • IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where... Read More
    IRIS Consultant 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 . 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 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. Required Qualifications • At least 2 years experience in health care, preferably in care coordination, and at least 1 year of experience serving target groups of the IRIS program (adults with intellectual/physical disabilities or older adults), or equivalent combination of relevant education and experience. • 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). • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements unless otherwise required by law. • Ability to develop positive and effective work relationships with coworkers, clients, participants, providers, regulatory agencies and vendors. • Ability to work independently with minimal supervision and demonstrate self-motivation. • Demonstrated knowledge of long-term care programs. • Familiarity with principles of self-determination. • Problem-solving and critical-thinking skills. • Excellent time-management and prioritization skills. • Ability to focus on multiple projects simultaneously and adapt to change. • Ability to develop and maintain professional relationships and work through challenging situations. • Comfortable working within a variety of settings with ability to adjust style as needed to work with diverse populations, various personalities, and personal situations. • Demonstrated knowledge of community resources. • Proactive and detail-oriented. • Excellent verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V #PJHS #HTF Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
  • JOB DESCRIPTION Job Summary Leads and supervises a regionally-based te... Read More
    JOB DESCRIPTION Job Summary Leads and supervises a regionally-based team of The Management Group's (TMG) IRIS consultants - ensuring provision of high-quality, person-centered supports to IRIS participants, and achievement of TMG's organizational goals. Contributes to overarching strategy to provide quality and cost-effective care. Essential Job Duties • Provides leadership, training and supervision to reporting team of IRIS consultants - establishing relationships and rapport to drive optimal outcomes. • Demonstrates concept of self-direction and person-centered practices. • Reviews and utilizes data and reports to manage IRIS consultation services requirements, and identifies proactive solutions for the team. • Conduct reviews for pre-determined number of IRIS consultant records each month and documents results - emphasizing timelines, documentation standards, and plan accuracy. • Reviews and authorizes participant plans, budget amendments, one-time expense requests, and liaises for vendors as needed. • Communicates clearly and effectively with IRIS consultants and/or participants in the IRIS program about topics including: directives from the Department of Health Services (DHS) regarding programmatic changes, participant budget reductions and terminations. • Assists IRIS consultants with difficult situations and messaging, (i.e. fraud and conflict of interest), and maintains strictest confidentiality regarding all employee and participant related information including Health Insurance Portability and Accountability Act (HIPAA) and other personal or organizational information. • Acts as a change management conduit and communicates, assesses or interprets program, policy or protocol changes, staff changes and conflict of interest situations. • Works collaboratively with other staff, participants and stakeholders to ensure that service excellence standards are being met. • Responsible for outreach and networking opportunities with external stakeholders. • Meets regularly with area leaders and staff to discuss important participants issues or topics as needed, holds monthly team meetings, attends quarterly leadership development, and attends home visits with each IRIS consultant annually. • Local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 5 years health care, preferably in care coordination, and at least 2 years of experience serving the target groups of the IRIS program (adults with physical/intellectual disabilities or older adults), or equivalent combination of relevant education and experience. • A bachelor's degree in social work, psychology, human services, counseling, nursing, special education or a closely related field, and one year of direct experience related to the delivery of social services to the target groups required. May consider at least 5 years of experience related to delivery of social services to the target groups IRIS serves in lieu of degree. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements. • Demonstrated competencies in the following: professionalism, leadership, performance management, team development, and data analytics. • Knowledge of long-term care programs, and familiarity with principles of self-determination. • Demonstrated knowledge of community resources. • Proactive and detail-oriented. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Responsive in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships and collaborate in a highly matrixed organization. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving and critical-thinking skills • Communication outreach and partnership development experience. • Experience working with elderly and people with physical disabilities and developmental disabilities. • Ability to take ownership of an assigned area and corresponding programs, and lead with success. • Excellent verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Supervisory/leadership experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V #PJHS #HTF Pay Range: $54,922 - $107,099 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
  • Consultant, IRIS (Ashland County, WI & Bayfield County, WI)  

    - Bayfield County
    IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where... Read More
    IRIS Consultant 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 . 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 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. Required Qualifications • At least 2 years experience in health care, preferably in care coordination, and at least 1 year of experience serving target groups of the IRIS program (adults with intellectual/physical disabilities or older adults), or equivalent combination of relevant education and experience. • 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). • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements unless otherwise required by law. • Ability to develop positive and effective work relationships with coworkers, clients, participants, providers, regulatory agencies and vendors. • Ability to work independently with minimal supervision and demonstrate self-motivation. • Demonstrated knowledge of long-term care programs. • Familiarity with principles of self-determination. • Problem-solving and critical-thinking skills. • Excellent time-management and prioritization skills. • Ability to focus on multiple projects simultaneously and adapt to change. • Ability to develop and maintain professional relationships and work through challenging situations. • Comfortable working within a variety of settings with ability to adjust style as needed to work with diverse populations, various personalities, and personal situations. • Demonstrated knowledge of community resources. • Proactive and detail-oriented. • Excellent verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V #PJHS #HTF Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
  • Care Manager (must reside in Wisconsin)  

    - Brown County
    JOB DESCRIPTION Job Summary Provides support for care management/care... Read More
    JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments. • Develops and implements care plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member caseload for regular outreach and management. • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. • Facilitates interdisciplinary care team (ICT) meetings 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 concerns. • Collaborates with licensed care managers/leadership as needed or required. • 25- 40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. • Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and self-motivation. • Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V #PJHS #HTF Pay Range: $24 - $46.81 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
  • JOB DESCRIPTION Job Summary The Provider Engagement Specialist, role i... Read More
    JOB DESCRIPTION Job Summary The Provider Engagement Specialist, role implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the smaller, less advanced Tier 2 and Tier 3 providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for the Provider Engagement team. Communicates effectively with healthcare professionals and maintains compliance with policies. Job Duties • Ensures assigned Tier 2 works collaboratively within the Health Plan and with shared service partners to ensure alignment to business goals. • Accountable for use of standard Molina Provider Engagement reports and training materials. • Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities. • Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies. • Communicates comfortably and effectively with Physician Leaders, Providers, Practice Managers, Medical Assistants within assigned provider practices. • Maintains the highest level of compliance. • This position may require same day out of office travel approximately 0 - 80% of the time, depending upon location. JOB QUALIFICATIONS REQUIRED QUALIFICATIONS: • Associate’s degree or equivalent combination of education and work experience. • 1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience. • Working knowledge of Quality metrics and risk adjustment practices across all business lines • Demonstrates data analytic skills • Operational knowledge and experience with PowerPoint, Excel, Visio • Effective communication skills • Strong leadership skills" 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. #PJCore #LI-AC1 #HTF Pay Range: $43,121 - $88,511.46 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
  • JOB DESCRIPTION Job Summary The Provider Engagement Specialist, role i... Read More
    JOB DESCRIPTION Job Summary The Provider Engagement Specialist, role implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the smaller, less advanced Tier 2 and Tier 3 providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for the Provider Engagement team. Communicates effectively with healthcare professionals and maintains compliance with policies. Job Duties • Ensures assigned Tier 2 works collaboratively within the Health Plan and with shared service partners to ensure alignment to business goals. • Accountable for use of standard Molina Provider Engagement reports and training materials. • Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities. • Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies. • Communicates comfortably and effectively with Physician Leaders, Providers, Practice Managers, Medical Assistants within assigned provider practices. • Maintains the highest level of compliance. • This position may require same day out of office travel approximately 0 - 80% of the time, depending upon location. JOB QUALIFICATIONS REQUIRED QUALIFICATIONS: • Associate’s degree or equivalent combination of education and work experience. • 1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience. • Working knowledge of Quality metrics and risk adjustment practices across all business lines • Demonstrates data analytic skills • Operational knowledge and experience with PowerPoint, Excel, Visio • Effective communication skills • Strong leadership skills" 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. #PJCore #LI-AC1 #HTF Pay Range: $43,121 - $88,511.46 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
  • Care Manager (must reside in Wisconsin)  

    - Dane County
    JOB DESCRIPTION Job Summary Provides support for care management/care... Read More
    JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments. • Develops and implements care plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member caseload for regular outreach and management. • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. • Facilitates interdisciplinary care team (ICT) meetings 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 concerns. • Collaborates with licensed care managers/leadership as needed or required. • 25- 40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. • Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and self-motivation. • Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V #PJHS #HTF Pay Range: $24 - $46.81 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
  • Family Care with My Choice Wisconsin JOB DESCRIPTION Job Summary Provi... Read More
    Family Care with My Choice Wisconsin JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. • Facilitates comprehensive waiver enrollment and disenrollment processes. • Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. • Performs ongoing monitoring of 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 (LTSS) and home and community resources to enhance continuity of care. • Assesses for medical necessity and authorizes all appropriate waiver services. • Evaluates covered benefits and advises appropriately regarding funding sources. • Facilitates interdisciplinary care team (ICT) 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 and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. • Identifies critical incidents and develops prevention plans to assure member health and welfare. • Collaborates with licensed care managers/leadership as needed or required. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. •Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Demonstrated knowledge of community resources. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work independently, with minimal supervision and self-motivation. • Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). Preferred Qualifications • Certified Case Manager (CCM), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice. • Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V #PJHS #HTF Pay Range: $24 - $46.81 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
  • Consultant, IRIS (Ashland County, WI & Bayfield County, WI)  

    - Ashland County
    IRIS Consultant JOB DESCRIPTION Job Summary Do you want a career where... Read More
    IRIS Consultant 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 . 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 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. Required Qualifications • At least 2 years experience in health care, preferably in care coordination, and at least 1 year of experience serving target groups of the IRIS program (adults with intellectual/physical disabilities or older adults), or equivalent combination of relevant education and experience. • 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). • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements unless otherwise required by law. • Ability to develop positive and effective work relationships with coworkers, clients, participants, providers, regulatory agencies and vendors. • Ability to work independently with minimal supervision and demonstrate self-motivation. • Demonstrated knowledge of long-term care programs. • Familiarity with principles of self-determination. • Problem-solving and critical-thinking skills. • Excellent time-management and prioritization skills. • Ability to focus on multiple projects simultaneously and adapt to change. • Ability to develop and maintain professional relationships and work through challenging situations. • Comfortable working within a variety of settings with ability to adjust style as needed to work with diverse populations, various personalities, and personal situations. • Demonstrated knowledge of community resources. • Proactive and detail-oriented. • Excellent verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V #PJHS #HTF Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less
  • Care Manager (must reside in Wisconsin)  

    - La Crosse County
    JOB DESCRIPTION Job Summary Provides support for care management/care... Read More
    JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments. • Develops and implements care plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member caseload for regular outreach and management. • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. • Facilitates interdisciplinary care team (ICT) meetings 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 concerns. • Collaborates with licensed care managers/leadership as needed or required. • 25- 40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. • Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and self-motivation. • Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V #PJHS #HTF Pay Range: $24 - $46.81 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Read Less

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