Care Manager, LTSS (RN) (Boston/Dorchester area)

Molina Talent Acquisition; Boston (MA); Presencial; USD 70.000 - 100.000; Jornada completa

Descripción de la vacante

Molina Healthcare, Inc. is seeking an experienced Registered Nurse care manager to coordinate LTSS and care across the continuum for high-need members in the Boston area.

You will collaborate with a multidisciplinary team, develop and monitor care plans, and ensure timely assessments and waiver services while addressing barriers to care. This role requires independence, strong communication, and up to 40% local travel.

Formación

• 2+ years in health care with care management/LTSS experience.
• RN license active in state of practice.
• In some states, a bachelor's in health care may be required.
• Valid driver's license and reliable transportation.
• Strong verbal and written communication skills.
• Proactive, detail-oriented, able to work with diverse populations.

Responsabilidades

• Complete comprehensive member assessments within regulated timelines, including home visits.
• Coordinate waiver enrollment/disenrollment processes.
• Develop and implement care plans with members and providers.
• Monitor and adjust care plans based on progress and outcomes.
• Promote integration of LTSS with behavioral health services and community resources.
• Assess medical necessity and authorize waiver services.
• Lead ICT meetings for service approval/denial and collaboration.
• Support members with psycho/social, financial, and medical barriers.

Conocimientos

Care coordination

Patient advocacy

Multidisciplinary collaboration

Time management

Communication

Problem-solving

Educación

Registered Nurse (RN) license

Bachelor's degree in healthcare (optional)

Herramientas

Microsoft Office

Descripción del empleo

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.

Benefits & Compensation

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.