Care Manager, LTSS (RN) - (must reside in Michigan)

Socket.dev; Long Beach (CA); On-site; USD 75,000 - 105,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is seeking a registered nurse to support care management and care coordination for LTSS across the Michigan plan. The role is member-facing with anticipated travel up to 50% locally.

You will conduct comprehensive assessments, develop care plans with a multidisciplinary team, and monitor progress to achieve member outcomes while ensuring high-quality, cost-effective care delivery.

Qualifications

• At least 2 years of experience in health care, including 1 year in care management or LTSS
• RN license active and unrestricted in state of practice
• Bachelor’s degree in health care-related field may be required in some states
• Valid driver’s license and reliable transportation for travel requirements
• Ability to work independently and manage multiple priorities
• Strong communication and problem-solving skills
• Experience with populations needing LTSS or disability services preferred

Responsibilities

• Complete comprehensive member assessments within regulated timelines, including home visits as required.
• Facilitate waiver enrollment and disenrollment processes.
• Develop and monitor care plans with members, caregivers, physicians, and the care network.
• Monitor interventions and adjust care plans to achieve member outcomes.
• Coordinate with ICT meetings for service approvals/denials and collaboration.
• Educate and motivate members using motivational interviewing and clinical guidelines.
• Travel 25-40% locally as required by state/contractuals.

Skills

RN License

Care management

Communication skills

Time management

Microsoft Office

Travel readiness

Detail-oriented

Multidisciplinary collaboration

Education

Registered Nurse (RN) License

Bachelor’s degree in health-related field (optional)

Tools

MS Office

Job description

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.

This position supports the Michigan health plan (Wayne and Macomb counties). This position is member facing. Anticipated travel is approximately 50 percent of the time.

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 including services such as waiver services which supports members looking to stay in the community setting.
• 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