RN Care Navigator: LTSS & Waiver Care Coordination

Molina Healthcare; Hillsboro (IL); On-site; USD 79,457,000 - 155,136,000; Full time

Benefits offered by this job

Competitive benefits

Equal Opportunity Employer

Job summary

Molina Healthcare is seeking a registered nurse to support care management and coordination for LTSS-eligible members. You will collaborate with a multidisciplinary team to deliver integrated care and improve outcomes while managing costs.

Responsibilities include comprehensive assessments, waiver enrollment, care plan development, monitoring, and coordination with providers, caregivers, and community resources. Travel may be required to meet state contract requirements.

Qualifications

• At least 2 years of health care experience with 1 year in care management or LTSS.
• Active RN license in state of practice.
• Bachelor's degree in health care may be required depending on state.
• Valid driver's license and auto insurance for required travel.
• Ability to work independently and with diverse populations.

Responsibilities

• Completes comprehensive member assessments within regulated timelines and conducts in-person home visits as required.
• Facilitates waiver enrollment and disenrollment processes and coordinates with the multidisciplinary team.
• Develops and implements care plans, including waiver service plans with members, caregivers, and providers.
• Monitors care plan effectiveness, documents interventions, and updates goals as needed.
• Promotes integration of LTSS and behavioral health services with community resources.
• Assesses medical necessity and authorizes waiver services; evaluates benefits and funding sources.
• Leads ICT meetings for service approvals/denials and supports care coordination.
• Educates and motivates members using motivational interviewing and Molina guidelines.
• Identifies barriers to care and coordinates psycho-social, financial, and medical support.
• May provide consultation and resources to peers; some cases may involve complex regimens.
• Travel 25-40% may be required based on state/contractual requirements.

Skills

RN license

Care management

LTSS experience

Communication skills

Microsoft Office

Travel readiness

Education

Nursing degree or equivalent

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a registered nurse to support care management and coordination for LTSS-eligible members. You will collaborate with a multidisciplinary team to deliver integrated care and improve outcomes while managing costs.

Responsibilities include comprehensive assessments, waiver enrollment, care plan development, monitoring, and coordination with providers, caregivers, and community resources. Travel may be required to meet state contract requirements.