RN Care Manager: LTSS & Waiver Services

Jobtome; New Richmond (OH); On-site; USD 36,000 - 71,000; Full time

Job summary

Molina Healthcare is seeking a qualified Care Manager RN to support care management and LTSS coordinating services. You will collaborate with multidisciplinary teams to ensure member progress toward outcomes and to align care delivery across home, clinic, and community settings.

You will conduct comprehensive assessments, develop and monitor care plans, authorize waiver services, review benefits, and coordinate with ICT meetings.

Qualifications

• At least 2 years of experience in health care, including at least 1 year in care management or managed care.
• Registered Nurse (RN). Active and unrestricted license in state of practice.
• In some states, a bachelor's degree in a health care related field may be required.
• Valid and unrestricted driver's license, reliable transportation and auto insurance for job-related travel.
• Ability to operate proactively with detail-oriented work and strong self-motivation.
• Experience working with diverse populations and various settings.

Responsibilities

• Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
• Facilitates waiver enrollment and disenrollment processes.
• Develops and implements care plans with members, caregivers, physicians and support network.
• Monitors care plan effectiveness and documents interventions and goal achievement.
• Promotes integration of services across LTSS and behavioral health to ensure continuity of care.
• Assesses medical necessity and authorizes waiver services; evaluates benefits and funding sources.
• Leads ICT meetings for approval/denial of services and collaboration.
• Uses motivational interviewing and clinical guidelines to educate and motivate change.
• Identifies barriers and provides care coordination to address psycho/social, financial, and medical obstacles.
• Manages high-need cases and may perform medication reconciliation when needed.
• Travel up to 25-40% as required by state/contractual requirements.

Skills

Care coordination

Behavioral health

Communication

Time management

Problem-solving

Microsoft Office

Travel-ready

Education

RN license

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a qualified Care Manager RN to support care management and LTSS coordinating services. You will collaborate with multidisciplinary teams to ensure member progress toward outcomes and to align care delivery across home, clinic, and community settings.

You will conduct comprehensive assessments, develop and monitor care plans, authorize waiver services, review benefits, and coordinate with ICT meetings.