Care Manager, Ltss (Rn)

Jobtome; Madison (WI); On-site; USD 38,000 - 74,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

Molina Healthcare is hiring a registered nurse to provide care management and coordination for LTSS programs. The role collaborates with a multidisciplinary team to deliver integrated member care and achieve desired outcomes.

The position requires in-person assessments, program enrollment responsibilities, and ongoing care plan tracking, with travel as required by state contracts. A strong emphasis is placed on using motivational interviewing to support member progress.

Qualifications

• Active RN license in state of practice (unrestricted).
• Experience in care management, managed care, or LTSS settings.
• Strong communication and interpersonal skills.

Responsibilities

• Completes comprehensive member assessments within regulated timelines, including in-person home visits.
• Facilitates waiver enrollment/disenrollment processes.
• Develops and implements care plans with members and care networks.
• Monitors care plan effectiveness and documents interventions.
• Promotes integration of LTSS with behavioral health and community resources.
• Assesses medical necessity and authorizes waiver services.
• Coordinates ICT meetings for service approvals/denials.
• Educates and motivates members during contacts using motivational interviewing.
• Identifies barriers to care and coordinates solutions.
• May supervise complex cases and perform medication reconciliation.

Skills

Communication skills

Detail-oriented

Time management

Problem solving

Education

RN license (active)

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.


• Assesss 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.

PAY RANGE

$27.73 - $54.06 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.