Care Manager, Ltss (Rn)

Molina Healthcare, Inc.; Weymouth (MA); Vor Ort; USD 42.000 - 82.000; Vollzeit

Zusammenfassung

Molina Healthcare, Inc. in Weymouth, MA is seeking a registered nurse care manager to support LTSS care coordination across settings and collaborate with a multidisciplinary team.

You will conduct comprehensive assessments, develop and monitor care plans, facilitate waiver enrollment, and ensure timely care while addressing barriers. Travel of 25–40% may be required. A valid RN license is required, and CCM is preferred; strong communication, organization and problem-solving skills are essential.

Qualifikationen

• 2+ years in health care including care management, managed care or LTSS related setting
• Active RN license in practicing state
• Bachelor degree may be required in some states
• Valid driver's license and reliable transportation for travel
• Proactive, detail-oriented, with strong communication skills
• Experience with diverse populations and multi-setting care coordination

Aufgaben

• Complete comprehensive member assessments within timelines and via home visits as needed
• Coordinate waiver enrollment/disenrollment processes
• Develop and implement care plans with members and care network
• Monitor care plan effectiveness and adjust as needed
• Promote integrated services across LTSS and behavioral health
• Assess medical necessity and authorize waiver services
• Evaluate benefits and advise on funding sources
• Lead ICT meetings for service approvals/denials
• Identify barriers to care and coordinate support
• May provide consultation to peers and support complex cases
• Expect 25-40% local travel based on state requirements

Kenntnisse

Communication skills

Time management

Problem-solving

Organization

Microsoft Office

Ausbildung

RN license

Bachelor's degree in healthcare

Tools

Microsoft Office

Jobbeschreibung

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

Pay Range: $30.37 - $59.21 / HOURLY

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