Case Manager, LTSS (RN)

Molina Healthcare; Rosemont (IL); Hybrid; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager (RN) to support its Medicaid population in Illinois. This entry-level, full-time role involves conducting comprehensive assessments and developing tailored care plans for members with high needs. The ideal candidate will possess strong computer skills, attention to detail, and a passion for helping others. With a flexible schedule primarily working remotely and opportunities for field visits, this position offers a unique blend of independence and teamwork. Join a forward-thinking organization committed to delivering quality, integrated care while making a meaningful impact in the community.

Qualifications

• 1-3 years in case management, disease management, or behavioral health.
• Active Illinois RN license in good standing required.

Responsibilities

• Conduct face-to-face assessments and develop care plans.
• Monitor care plan effectiveness and suggest adjustments.
• Travel 50-75% for member visits.

Skills

Assessment Skills

Case Management

Multitasking

Motivational Interviewing

Documentation Skills

Education

Graduate from an accredited School of Nursing

Bachelor’s Degree in Nursing

Tools

High-speed Internet

Computer Skills

Job description

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Job Description

We are seeking a (RN) Registered Nurse who lives in Illinois and must be licensed for the state of Illinois.

The Case Manager will work in remote and field settings supporting our Medicaid Population. The role requires physical visits to members' homes for Face-to-Face assessments, participation in interdisciplinary care team meetings, and ensuring care plans are tailored to members' needs. Members require assessments every six months and trigger assessments after hospitalizations. Excellent computer skills, attention to detail, and multitasking abilities are essential. This position involves travel (50% or more) within the surrounding areas, primarily working remotely in the Rosemont area. A home office with high-speed internet is required. The schedule is Monday through Friday, 8:00 AM to 5:00 PM, with no weekends or holidays.

Job Summary

Molina Healthcare Services works with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate integrated care across the continuum, including behavioral health and long-term care, for members with high needs. The goal is to ensure quality, medically appropriate, and cost-effective care based on the severity of illness and site of service.

Knowledge/Skills/Abilities

• Complete face-to-face comprehensive assessments within regulated timelines.
• Facilitate waiver enrollment and disenrollment processes.
• Develop and implement case management and waiver service plans collaboratively with members and healthcare professionals.
• Monitor and evaluate care plan effectiveness, document interventions, and suggest adjustments.
• Promote service integration, including behavioral health and long-term services and supports.
• Assess medical necessity and authorize waiver services.
• Evaluate benefits and advise on funding sources.
• Conduct face-to-face or home visits as needed.
• Facilitate interdisciplinary care team meetings for service approval or denial.
• Use motivational interviewing and clinical guidelines to support members.
• Identify barriers to care and provide coordination to address psycho/social, financial, and medical obstacles.
• Develop prevention plans for critical incidents.
• Provide consultation and education to non-RN case managers.
• Manage cases involving complex medical conditions and medications, including medication reconciliation.
• Travel 50-75% for member visits.

Job Qualifications

Required Education: Graduate from an accredited School of Nursing.

Required Experience:

• At least 1 year working with persons with disabilities or chronic conditions and Long Term Services & Supports.
• 1-3 years in case management, disease management, managed care, or behavioral health settings.

Required License, Certification, and Association: Active, unrestricted Illinois RN license in good standing. Valid driver’s license and reliable transportation if field work is required.

State-Specific Requirements: Virginia: At least one year of experience with individuals with Substance Use Disorders.

Preferred Education: Bachelor’s Degree in Nursing.

Preferred Experience:

• 3-5 years in relevant healthcare management roles.
• Experience working with waiver services population.

Preferred License, Certification, and Association: Certified Case Manager (CCM).

Interested employees should apply through the intranet. Molina offers competitive benefits. This role is an entry-level, full-time position in healthcare provider services, primarily in hospitals and healthcare industries.