Care Manager, LTSS (RN) Remote (Detroit, MI)

NEPSE Trading; Detroit, Northern (MI, KY); Hybrid; USD 58,000 - 78,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

NEPSE Trading is seeking an RN Care Manager to support care coordination for LTSS, collaborating with a multidisciplinary team to deliver integrated member care. You will conduct assessments, develop and monitor care plans, and ensure quality outcomes while traveling as required.

The role emphasizes strong communication, organization, and the ability to work independently within regulated timelines and diverse settings.

Qualifications

• RN license active in state of practice.
• 2+ years of health care experience, including care management or LTSS.
• Experience with disability, chronic conditions or substance use disorders.

Responsibilities

• Performs comprehensive member assessments within regulated timelines, including home visits as required.
• Coordinates waiver enrollment/disenrollment and develops care plans with the member and care network.
• Monitors and documents progress, adjusting interventions as needed.
• Promotes integrated LTSS and behavioral health services to improve continuity of care.
• Assesses medical necessity, authorizes waiver services, and evaluates benefits.
• Facilitates ICT meetings and collaborates with the team to approve or deny services.
• Travel 25-40% as required.

Skills

Verbal communication

Written communication

Time management

Problem solving

Detail oriented

Independent work

MS Office

Education

Active RN license

Bachelor's degree in healthcare

Tools

MS Office

EHR systems

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.
• 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