Care Manager, LTSS (RN)

Molina Healthcare; Wisconsin; Remote; USD 70,000 - 90,000; Full time

Job summary

Molina Healthcare is seeking a Registered Nurse Care Manager to support care management and LTSS services in Wisconsin. The role collaborates with a multidisciplinary team to coordinate member care across settings, with emphasis on high-need individuals and cost-effective outcomes.

Responsibilities include conducting comprehensive assessments, developing care plans, monitoring progress, and facilitating waiver enrollment and service coordination.

Qualifications

• At least 2 years of health care experience including care management or LTSS exposure.
• RN license active and unrestricted in state of practice.
• Experience with diverse populations and waiver services is preferred.

Responsibilities

• Completes comprehensive member assessments within regulated timelines, including in-person home visits.
• Facilitates waiver enrollment and disenrollment processes.
• Develops and implements care plans with members and care network.
• Monitors care plan effectiveness and documents interventions.
• Promotes integration of services including behavioral health and LTSS.
• Assesses medical necessity and authorizes waiver services.
• Facilitates ICT meetings for service approvals/denials.
• Educates and motivates members during interactions using guiding principles.
• Identifies barriers to care and coordinates solutions.
• Travel 25-40% for member visits within WI.

Skills

RN

Care coordination

Home visits

Motivational interviewing

Microsoft Office

Education

Registered Nurse (RN) license

Tools

Electronic Health Records (EHR)

Job description

*Remote with travle throughout La Crosse, Monroe, & Trempealeau Counties, WI for member visits***

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.


• Assess 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