Care Manager, LTSS (RN)

IntelliResume; Worcester (MA); On-site; USD 85,962,000 - 169,059,000; Full time

Job summary

Molina Healthcare is hiring a Care Manager, LTSS (RN) in Worcester, MA. This role focuses on coordinating long-term services and supports, performing home assessments, and guiding waiver processes to improve member outcomes.

You will develop care plans with members and the care team, monitor progress, and ensure appropriate services are authorized and funded. A valid RN license and 2+ years in healthcare are required, with travel involved.

Qualifications

• Active and unrestricted RN license in state of practice.
• 2+ years healthcare experience; 1+ year in care/managed care.
• Experience with disabilities, chronic conditions, or substance use disorders.
• Valid driver’s license with reliable transportation.

Responsibilities

• Complete comprehensive member assessments within timelines, including in-person home visits.
• Facilitate waiver enrollment and disenrollment processes.
• Develop and implement care plans with members, caregivers and professionals.
• Monitor care plans for effectiveness and adjust as needed.
• Promote integration of services including behavioral health and LTSS.
• Assess medical necessity and authorize waiver services.
• Evaluate covered benefits and advise on funding sources.
• Lead interdisciplinary care team meetings for approvals/denials.
• Use motivational interviewing to educate and support members.
• Identify barriers to care and coordinate to address obstacles.
• Develop prevention plans for critical incidents.
• Conduct medication reconciliation as needed.
• Estimated 25-40% local travel may be required.

Skills

Care coordination

Interdisciplinary teamwork

Motivational interviewing

Assessments

Education

RN License - active

Bachelor’s degree in healthcare (optional)

Job description

About This Role

The Care Manager, LTSS (RN) at Molina Healthcare provides support for care management and coordination of long-term services and supports (LTSS). This role is ideal for RNs who are passionate about collaborating with multidisciplinary teams to enhance member care and outcomes.

Highlights

• Pay: $30 - $59/hour
• Location: Worcester, MA
• Schedule: Full Time

What You'll Do

• Complete comprehensive member assessments within regulated timelines, including in-person home visits as required.
• Facilitate comprehensive waiver enrollment and disenrollment processes.
• Develop and implement care plans in collaboration with members, caregivers, and healthcare professionals.
• Perform ongoing monitoring of care plans to evaluate effectiveness and suggest changes.
• Promote integration of services for members, including behavioral health care and LTSS.
• Assess for medical necessity and authorize appropriate waiver services.
• Evaluate covered benefits and advise on funding sources.
• Facilitate interdisciplinary care team meetings for service approval or denial.
• Use motivational interviewing to educate and support members.
• Assess for barriers to care and provide coordination to address obstacles.
• Identify critical incidents and develop prevention plans.
• Conduct medication reconciliation as needed.
• Estimated 25-40% local travel may be required.

Requirements

Education:

• 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.

Experience:

• At least 2 years of experience in health care, including 1 year in care management or managed care.
• Experience working with persons with disabilities, chronic conditions, or substance abuse disorders.

Licenses & Certifications:

• Valid and unrestricted driver's license.
• Reliable transportation and adequate auto insurance for job-related travel.

About Molina Healthcare

Molina Healthcare is a leading healthcare provider committed to delivering exceptional patient care. They focus on providing quality and cost-effective services to members across various healthcare needs.