RN Care Manager, LTSS & Home-Based Care

Molina Healthcare; Monroe (WI); On-site; USD 36,000 - 70,000; Full time

Job summary

Molina Healthcare is seeking a Care Manager RN in Wisconsin to support care management and coordination for LTSS members. You will collaborate with an interdisciplinary team to develop and monitor care plans, assess medical necessity, and facilitate waiver enrollment while addressing barriers to care.

Travel of 25-40% may be required based on contract and state guidelines. The role requires governance over complex cases, strong communication, and proficiency with Microsoft Office and healthcare

Qualifications

• At least 2 years in health care, incl. care management and LTSS.
• Active RN license in state of practice.
• Bachelor's degree in health care field may be required in some states.
• Valid driver's license and reliable transportation for travel.
• Ability to handle multiple projects and adapt to change.

Responsibilities

• Completes comprehensive member assessments within timelines, including home visits.
• Facilitates waiver enrollment/disenrollment processes.
• Develops and implements care plans with members and care network.
• Monitors care plan effectiveness and documents outcomes.
• Promotes integrated LTSS and behavioral health services.
• Assesses medical necessity and authorizes waiver services.
• Evaluates benefits and funding sources for members.
• Facilitates ICT meetings for service approvals/denials.
• Educates and motivates members during contacts.
• Identifies barriers to care and coordinates resources.
• Identifies critical incidents and develops prevention plans.
• May provide consultation to peers as needed.
• Local travel 25-40% may be required.

Skills

Strong verbal and written comms

Independent work

Time management

Problem solving

Detail oriented

Diversity + inclusion

Education

Registered Nurse (RN) license

Bachelor's degree in a health care field (may be required)

Tools

Microsoft Office

Healthcare software

Job description

Molina Healthcare is seeking a Care Manager RN in Wisconsin to support care management and coordination for LTSS members. You will collaborate with an interdisciplinary team to develop and monitor care plans, assess medical necessity, and facilitate waiver enrollment while addressing barriers to care.

Travel of 25-40% may be required based on contract and state guidelines. The role requires governance over complex cases, strong communication, and proficiency with Microsoft Office and healthcare