RN LTSS Care Manager — Care Coordination Expert

Molina Healthcare; Cleveland (OH); Presencial; USD 36.000 - 71.000; Jornada completa

Descripción de la vacante

Molina Healthcare is seeking an RN Care Manager to support care management and LTSS coordination across multiple counties. You will collaborate with multidisciplinary teams to deliver integrated member care, conduct home visits, and oversee waiver processes to meet member goals and ensure quality and cost-effective outcomes.

The role requires 2+ years in healthcare with care management experience, active RN license, and strong communication skills.

Formación

• At least 2 years of experience in health care, including at least 1 year in care management, managed care, and/or LTSS, or equivalent combination of education and experience.
• RN license must be active and unrestricted in state of practice.
• Bachelor's degree in a health care related field may be required in some states.
• Valid and unrestricted driver’s license with reliable transportation for job travel.
• Ability to operate proactively and demonstrate attention to detail.
• Knowledge of community resources.
• Ability to work in a variety of settings with diverse populations and personalities.
• Ability to work independently with minimal supervision and show self-motivation.
• Excellent written and verbal communication skills.
• Proficiency with Microsoft Office suite.
• In some states, at least 1 year of experience with individuals with substance use disorders.

Responsabilidades

• Completes comprehensive member assessments within regulated timelines, including in-person home visits.
• Facilitates waiver enrollment and disenrollment processes.
• Develops and implements care plans with members, caregivers, and care teams.
• Monitors care plan effectiveness, documents interventions, and suggests changes.
• Promotes integration of LTSS and behavioral health with home and community resources.
• Assesses medical necessity and authorizes waiver services.
• Evaluates covered benefits and advises on funding sources.
• Facilitates interdisciplinary care team meetings for service approvals/denials.
• Uses motivational interviewing and Molina guidance to educate and support change.
• Assesses barriers to care and provides coordination to address psycho-social, financial, and medical obstacles.
• Identifies critical incidents and develops prevention plans.
• Care manager RNs may handle complex cases and medication reconciliation.
• Travel 25-40% may be required based on state/contractual requirements.

Descripción del empleo

Molina Healthcare is seeking an RN Care Manager to support care management and LTSS coordination across multiple counties. You will collaborate with multidisciplinary teams to deliver integrated member care, conduct home visits, and oversee waiver processes to meet member goals and ensure quality and cost-effective outcomes.

The role requires 2+ years in healthcare with care management experience, active RN license, and strong communication skills.