Care Manager, LTSS (RN)

Molina Healthcare, Inc.; Cincinnati (OH); On-site; USD 70,000 - 95,000; Full time

Job summary

Molina Healthcare, Inc. is seeking an RN Care Manager to support care management and coordination for LTSS beneficiaries.

The role involves collaborating with a multidisciplinary team to deliver integrated member care and ensure progress toward outcomes, while aligning with the broader strategy for quality and cost-effective care. The position requires strong assessment, care planning, and coordination skills, plus the ability to travel locally up to 40% and work across diverse settings to

Qualifications

• At least 2 years of healthcare experience, including 1 year in care management or LTSS.
• RN license active and unrestricted in state of practice.
• Bachelor's degree in a health care field may be required in some states.
• Valid driver's license and reliable transportation for travel.
• Able to work independently, manage multiple tasks, and stay calm under pressure.
• Strong knowledge of community resources and ability to coordinate care across settings.
• Experience with populations with disabilities or chronic conditions is preferred.

Responsibilities

• Complete comprehensive member assessments within regulated timelines, including in-person home visits as required.
• Facilitate waiver enrollment and disenrollment processes.
• Develop and implement care plans with members, caregivers, physicians and team.
• Monitor care plan effectiveness, document interventions and outcomes, adjust as needed.
• Promote integration of LTSS and behavioral health services and link to community resources.
• Assess medical necessity and authorize waiver services.
• Coordinate ICT meetings for approvals/denials of services; collaborate with the team.
• Use motivational interviewing and Molina guides to educate and support change.
• Identify barriers to care and arrange psychosocial, financial, and medical support.
• Identify critical incidents and develop prevention plans; provide peer consultation when needed.
• Care manager RNs may handle complex cases and medication reconciliation as required.
• Travel 25-40% locally according to state/contractual requirements.

Skills

Communication

Time management

Detail oriented

Self-motivated

Independent worker

Proactive

Microsoft Office

Education

Registered Nurse (RN) license active

Bachelor's degree in health care field (state dependent)

Certified Case Manager (CCM) - preferred

Tools

Microsoft Office

Job description

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.
• 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.
• 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.

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