Field Care Manager, LTSS (RN) - Local Travel Required

Molina Healthcare; Dallas (TX); On-site; USD 3,638,000 - 7,093,000; Full time

Benefits offered by this job

Mileage reimbursement

Benefits package

Job summary

Molina Healthcare in Dallas, TX is seeking a Texas licensed RN to join as a Care Manager for Medicaid members. You will conduct in-home assessments, determine waiver service eligibility, and coordinate with physicians, caregivers and the care team to create and implement care plans.

The role requires solid Office proficiency (Outlook, Excel, Teams, OneNote), ability to travel 25-40%, and strong communication skills.

Qualifications

• RN with active license in state of practice.
• Minimum 2 years healthcare experience with care management exposure.
• Valid driver's license and reliable auto for travel.

Responsibilities

• Completes comprehensive member assessments including in-person home visits.
• Facilitates waiver enrollment and disenrollment processes.
• Develops and implements care plans with members and care team.
• Monitors care plan effectiveness and adjusts as needed.
• Promotes integration of LTSS, behavioral health, and community resources.
• Assesses medical necessity and authorizes waiver services.
• Facilitates ICT meetings for approvals/denials.
• Conducts medication reconciliation as needed.
• Travel 25-40% as required.

Skills

Microsoft Office proficiency

Strong communication

Travel readiness

Detail oriented

Education

RN license active

Tools

Outlook

Excel

Teams

OneNote

Job description

Job Description

Opportunity for Texas licensed RN to join Molina as a Care Manager working with our Medicaid members in Dallas, TX. If hired, you will conduct face-to-face meetings with the members in their homes, completing assessments needed for determining the types of waiver services they are eligible to receive. Preference will be given to those candidates with previous experience working with the LTSS population within an MCO. Mileage is reimbursed as part of our benefits package. Hours are Monday - Friday, 8 AM - 5 PM CST.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, Teams, and One Note as well as being confident in toggling between different programs to complete the necessary forms and documentation.

Job Summary

Provides support for care management/care coordination long-term services and supports specific activities and 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.
• Assess 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 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.
• 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.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving and critical-thinking 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

Pay Range: $26.41 - $51.49 / HOURLY

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.