Care Manager, LTSS (RN)

Molina Healthcare, Inc.; Chicago (IL); On-site; USD 70,000 - 90,000; Full time

Job summary

Molina Healthcare, Inc. in Chicago, IL, seeks an RN care manager to support LTSS care coordination, collaborating with a multidisciplinary team to deliver high-quality, cost-effective member care.

The role involves comprehensive assessments, waiver enrollment, care plan development, monitoring, and facilitating interdisciplinary meetings, with travel up to 40% as required. Candidates should have RN license and 2+ years in care management and related settings; strong communication and knowledge

Qualifications

• Active RN license in state of practice.
• 2+ years healthcare experience including 1 year in care management.
• Experience with disability, chronic conditions, LTSS or equivalent.
• Valid driver’s license and reliable transportation.
• Ability to work independently with minimal supervision.
• Strong communication and knowledge of community resources.
• Experience with substance use disorders is a plus.

Responsibilities

• Complete comprehensive member assessments within timelines.
• Coordinate waiver enrollment/disenrollment processes.
• Develop and implement care plans with members, caregivers and professionals.
• Monitor care plan effectiveness and adjust as needed.
• Promote integration of LTSS and behavioral health services.
• Assess medical necessity and authorize waiver services.
• Facilitate ICT meetings for approvals/denials.
• Local travel of 25-40% may be required.

Skills

Communication skills

Time management

Detail oriented

Problem solving

Self motivation

Education

RN license

Bachelor's in health field

Tools

Microsoft Office

Job description

Job Summary

Provides support for care management/care coordination long-term services and supports (LTSS)-specific activities. 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.
• Assess 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.
• May provide consultation, resources and recommendations to peers as needed.
• Care manager RNs may be assigned complex member cases and medication regimens.
• Care manager RNs may conduct medication reconciliation as needed.
• 25-40% estimated local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 2 years of experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
• Registered Nurse (RN). 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.
• Ability to operate proactively and demonstrate detail-oriented work.
• Demonstrated knowledge of community resources.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Problem-solving skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
• In some states, must have at least one year of experience working directly with individuals with substance use disorders.

Preferred Qualifications

• Certified Case Manager (CCM).
• Experience working with populations that receive waiver services.

Benefits & Compensation

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.