Care Manager, LTSS (RN)

Molina Healthcare, Inc.; Oregon; Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare, Inc. is seeking a Care Manager RN to support LTSS and care coordination remotely with travel. You will collaborate with multidisciplinary teams to ensure high-need members receive quality, cost-effective care and to develop individualized care plans.

Responsibilities include comprehensive assessments, waiver processes, plan development, and monitoring. Travel up to 25-40% as required; travel may be statewide.

Qualifications

• Minimum 2 years in health care with 1 year in care management or LTSS.
• RN license active and unrestricted.
• Valid driver's license and ability to travel 25-40%.
• Ability to work independently and with diverse populations.

Responsibilities

• Complete comprehensive member assessments within mandated timelines, including in-person home visits.
• Facilitate waiver enrollment and disenrollment processes.
• Develop and implement care plans with members, caregivers, physicians and other health care professionals.
• Monitor care plans, document interventions and outcomes, and adjust as needed.
• Promote integration of LTSS, behavioral health and community resources.
• Assess medical necessity and authorize waiver services.
• Evaluate benefits and advise on funding sources.
• Facilitate ICT meetings for approval/denial of services.
• Use motivational interviewing to educate and motivate change.
• Identify barriers to care and assist with psycho/social, financial, medical issues.
• Identify critical incidents and develop prevention plans.
• May provide consultation to peers; RNs may handle complex cases and medication reconciliation.

Skills

Care coordination

Communication skills

Time management

Problem solving

Detail-oriented

Education

Registered Nurse (RN) license

Bachelor's degree in health care field

CCM certification

Job description

Remote with travel throughout Pierce and St. Croix Counties, WI for member visits

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