RN LTSS Care Manager — Care Coordination & Outcomes

Molina Healthcare, Inc.; Hilliard (OH); On-site; USD 36,000 - 71,000; Full time

Benefits offered by this job

Competitive benefits

Equal Opportunity Employer (EOE)

Job summary

Molina Healthcare, Inc. is seeking an RN Care Manager to support care coordination for LTSS across the member care continuum.

This role collaborates with a multidisciplinary team to develop and monitor care plans, ensuring outcomes and cost-effective care, with travel to member sites as required. The role requires a valid RN license, 2+ years in health care, including care management, and the ability to manage multiple priorities in diverse settings.

Qualifications

• 2+ years in health care with 1+ year in care management or LTSS.
• RN with active, unrestricted license in state of practice.
• Valid driver's license and reliable transportation for travel.

Responsibilities

• 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 long-term services and supports (LTSS) and home and community resources to enhance continuity of care.
• 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.
• Assesses 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).

Education

RN License (Active)

Job description

Molina Healthcare, Inc. is seeking an RN Care Manager to support care coordination for LTSS across the member care continuum.

This role collaborates with a multidisciplinary team to develop and monitor care plans, ensuring outcomes and cost-effective care, with travel to member sites as required. The role requires a valid RN license, 2+ years in health care, including care management, and the ability to manage multiple priorities in diverse settings.