Care Manager, Ltss (Rn)

Molina Healthcare, Inc.

Fairfield (OH)

In loco

USD 36.000 - 71.000

Tempo pieno

9 giorni fa

Una candidatura completa in un minuto

Curriculum e lettera di presentazione personalizzati, pronti da inviare.

Supera i filtri ATS

Descrizione del lavoro

Molina Healthcare, Inc. is seeking a Registered Nurse Care Manager to support LTSS care coordination. You will collaborate with a multidisciplinary team to coordinate member care across the continuum, ensuring progress toward outcomes and aligning with the organization’s quality and cost goals.

The role involves comprehensive assessments, care planning, and ongoing monitoring, with travel as required. Strong communication and independent work style are essential, along with proficiency in

Competenze

At least 2 years in health care with 1 year in care management or LTSS
Active RN license in state of practice
May require a healthcare-related bachelor's degree per state rules
Valid driver's license and reliable transportation for travel
Ability to work independently with minimal supervision
Strong communication, problem-solving, and time-management skills
Proficiency with Microsoft Office and applicable software

Mansioni

Complete comprehensive member assessments within timelines, including home visits as needed
Facilitate waiver enrollment/disenrollment processes
Develop and implement care plans with members, family, and providers
Monitor and adjust care plans based on outcomes and barriers
Promote integration of behavioral health and LTSS with community resources
Assess medical necessity and authorize waiver services, evaluate benefits
Prepare for ICT meetings and coordinate interdisciplinary collaboration
Provide education and support to members using motivational interviewing
Coordinate care and address psycho/social, financial, and medical obstacles
Travel 25-40% as required by state/contractual requirements

Conoscenze

Proactive work

Detail oriented

Community resources knowledge

Independent worker

Verbal and written communication

Microsoft Office proficiency

Formazione

RN license

Bachelor's degree (health care field)

Strumenti

Microsoft Office Suite

Descrizione del lavoro

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.