Filed Care Manager, LTSS (RN) – Local Travel Required

Molina Talent Acquisition; Houston (TX); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Mileage reimbursement

Job summary

Molina Healthcare seeks a Texas-licensed RN to join as Field Care Manager in Houston, covering Houston Heights, Shady Acres, Timber Grove and the Greater Fifth Ward. You will perform member assessments to determine eligible services and coordinate care across LTSS for Medicaid members.

Strong Microsoft Office skills and prior care-management experience are required; mileage is reimbursed. Travel within the coverage area is 25-40% and hours are Monday–Friday, 8 AM–5 PM CST.

Qualifications

• Active RN license in state of practice.
• Minimum 2 years in healthcare with at least 1 year in care management or managed care.
• Valid driver’s license and reliable transportation.
• Proficiency with Microsoft Office Suite.
• Ability to work independently with minimal supervision.

Responsibilities

• Complete comprehensive member assessments within regulated timelines, including in-person home visits as required.
• Facilitate comprehensive waiver enrollment and disenrollment processes.
• Develop and implement care plans with members, caregivers, physicians and team to address needs and goals.
• Monitor and evaluate care plan effectiveness, document interventions and goal achievement.
• Promote integration of services across LTSS and behavioral health to improve continuity of care.
• Assess medical necessity and authorize appropriate waiver services.
• Lead ICT meetings for approval/denial of services.
• Identify barriers to care and provide care coordination for psycho/social, financial, and medical obstacles.
• Travel 25-40% local travel may be required.

Skills

RN license

Care management experience

Strong communication

Travel willingness

Time-management

Microsoft Office proficiency

Education

Bachelor's degree in healthcare related field

Tools

Microsoft Office Suite

Job description

JOB DESCRIPTION

Opportunity for a Texas licensed RN to join Molina as a Field Care Manager to work with our Medicaid members in Houston covering Houston Heights, Shady Acres, Timber Grove, and the Greater 5^th^ Ward. You will complete assessments needed for determining the types of services our members are eligible to receive. Preference will be given to those candidates with previous experience working with the Medicaid population within a Managed Care Organization (MCO). Mileage is reimbursed as part of our benefits package, but we are only considering candidates who are within 30 - 45 minutes of the coverage area. Hours are Monday - Friday, 8 AM - 5 PM CST.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, One Note and Teams 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 (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.
• 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.
• 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