Case Manager, LTSS (RN) ILLINOIS

ClickJobs.io; Edwardsville (IL); On-site; Full time

Job summary

A leading healthcare provider seeks a Case Manager (RN) to coordinate integrated care for members with high needs in Illinois. The role involves comprehensive assessments, developing care plans, and continuous monitoring to ensure effective service delivery. Ideal candidates will have a nursing degree, relevant experience, and an active RN license. Competitive pay and benefits are offered.

Benefits

Competitive benefits

Qualifications

• At least 1 year working with persons with disabilities/chronic conditions.
• Active, unrestricted State RN license in Illinois required.

Responsibilities

• Complete face-to-face comprehensive assessments of members.
• Develop and implement case management and waiver service plans.
• Monitor care plans and suggest adjustments.

Skills

Assessment

Care Coordination

Motivational Interviewing

Case Management

Education

Bachelor's Degree in Nursing

Graduate from an accredited School of Nursing

Job description

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• Illinois residents preferred. Must reside and be willing to travel in Shiloh, O'Fallon, Lebanon, and Belleville, IL. Multiple county coverage.

Job Description

Job Summary

Molina Healthcare Services (HCS) collaborates 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. HCS staff work to ensure patient progress toward desired outcomes with quality, medically appropriate, and cost-effective care based on illness severity and site of service.

Knowledge/Skills/Abilities

• Complete face-to-face comprehensive assessments of members within regulated timelines.
• Facilitate waiver enrollment and disenrollment processes.
• Develop and implement case management and waiver service plans collaboratively with members, caregivers, and healthcare professionals to address needs and goals.
• Monitor care plans continuously, evaluate effectiveness, document interventions, and suggest adjustments.
• Promote service integration, including behavioral health and long-term services, to enhance care continuity.
• Assess medical necessity and authorize waiver services accordingly.
• Evaluate benefits and advise on funding sources.
• Conduct face-to-face or home visits as required.
• Facilitate interdisciplinary team meetings for service approval or denial.
• Use motivational interviewing and clinical guideposts to educate and support members.
• Assess barriers to care, coordinate services, and address psycho/social, financial, and medical obstacles.
• Identify critical incidents and develop prevention plans.
• Provide consultation and education to non-RN case managers.
• Handle cases with complex medical conditions and medication regimens.
• Conduct medication reconciliation when needed.
• Travel 50-75% of the time.

Job Qualifications

Required Education

Graduate from an accredited School of Nursing.

Required Experience

• At least 1 year working with persons with disabilities/chronic conditions and Long Term Services & Supports.
• 1-3 years in case management, disease management, managed care, or behavioral health settings.
• Required License: Active, unrestricted State RN license in Illinois.
• If field work is required, valid driver's license, good driving record, and reliable transportation are necessary.

State Specific Requirements

Must be licensed in Illinois.

Preferred Education

Bachelor's Degree in Nursing.

Preferred Experience

• 3-5 years in relevant healthcare settings.
• Experience with waiver services preferred.

Preferred License, Certification, and Association

Active and unrestricted CCM certification preferred.

Interested current Molina employees should apply via the intranet.

Molina Healthcare offers competitive benefits. We are an EOE M/F/D/V.

Pay Range: $27.73 - $54.06/hourly. Actual pay may vary based on location, experience, education, and skills.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Healthcare Provider
• Industry: Human Resources Services