RN LTSS Care Manager: Integrated Care & Outcomes

Molina Healthcare; Illinois; On-site; USD 38,000 - 74,000; Full time

Job summary

Molina Healthcare is seeking a Care Manager RN in Illinois to support LTSS care coordination and member outcomes across the care continuum. You will collaborate with a multidisciplinary team, conduct comprehensive assessments, develop and monitor care plans, and facilitate waiver enrollment when needed.

The role emphasizes medical necessity reviews, coordination of behavioral health services, and proactive problem solving. Travel 25-40% may be required to meet state contract expectations.

Qualifications

• At least 2 years in health care, including care management/LTSS experience.
• Active RN license in state of practice.
• Valid driver’s license and reliable transportation.
• Experience working with persons with disabilities, chronic conditions, or LTSS is preferred.

Responsibilities

• Complete comprehensive member assessments within regulated timelines, including in-person home visits.
• Facilitate waiver enrollment and disenrollment processes.
• Develop and implement care plans with members, caregivers, physicians and other health care professionals.
• Monitor care plans to evaluate effectiveness and document interventions and outcomes.
• Promote integration of services (behavioral health, LTSS, home and community resources) to ensure continuity of care.
• Assess medical necessity and authorize waiver services.
• Evaluate covered benefits and advise on funding sources.
• Facilitate ICT meetings for approval/denial of services and collaboration.
• Educate and motivate members using motivational interviewing and Molina guidelines.
• Identify barriers to care and provide coordination to address psycho/social, financial, and medical obstacles.
• Identify critical incidents and develop prevention plans for member welfare.
• Care manager RNs may handle complex cases and medication regimens.

Skills

Detail-oriented

Communication skills

Time management

Problem solving

Multitasking

Education

Registered Nurse (RN) license

Bachelor's degree in health care

Driver's license

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a Care Manager RN in Illinois to support LTSS care coordination and member outcomes across the care continuum. You will collaborate with a multidisciplinary team, conduct comprehensive assessments, develop and monitor care plans, and facilitate waiver enrollment when needed.

The role emphasizes medical necessity reviews, coordination of behavioral health services, and proactive problem solving. Travel 25-40% may be required to meet state contract expectations.