RN Care Manager: LTSS & Waiver Services

Molina Talent Acquisition

Detroit (MI)

Sur place

USD 65 000 - 95 000

Plein temps

14 jours+

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Résumé du poste

Molina Healthcare is seeking a Registered Nurse Care Manager to support LTSS care coordination for the Michigan plan (Wayne and Macomb counties). The role is member-facing with travel approx. 50 percent to home visits and provider sites.

You will assess members, develop and monitor care plans, coordinate waiver services, and collaborate with an interdisciplinary team to improve quality and reduce costs while navigating diverse settings and complex cases.

Qualifications

At least 2 years in health care with 1 year in care management or LTSS.
Experience with disability, chronic conditions, or substance use disorders.
Active RN license in state of practice.
Valid driver's license and reliable transportation for travel.
Ability to work with multidisciplinary teams and travel as required.
Strong verbal and written communication skills.
Experience with community resources and care coordination.

Responsabilités

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 LTSS and home and community resources to enhance continuity of care including services such as waiver services which supports members looking to stay in the community setting.
Assesses 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).