Care Manager, LTSS (RN) (Boston/Dorchester area)

Molina Healthcare•Long Beach, CA

About The Position

Provides support for care management and care coordination activities specific to long-term services and supports (LTSS). Collaborates with a multidisciplinary team to coordinate integrated member care across the continuum for members with high-need potential. Works to help members progress toward desired outcomes and contributes to the strategy of providing quality, cost-effective care. The role includes comprehensive member assessments, waiver enrollment and disenrollment, care planning and monitoring, service integration, medical-necessity assessments, waiver-service authorization, and coordination of interdisciplinary care team meetings. The care manager uses motivational interviewing and clinical guideposts to educate and support members; identifies barriers to care and critical incidents; and helps address members’ psychosocial, financial, and medical needs. Care manager RNs may be assigned complex cases and medication regimens and may conduct medication reconciliation. Local travel of approximately 25–40% may be required based on state or contractual requirements.

Requirements

At least 2 years of health care experience, including at least 1 year in care management, managed care, or a medical or behavioral health setting, and at least 1 year working with people with disabilities, chronic conditions, substance abuse disorders, or LTSS; an equivalent combination of relevant education and experience is acceptable.
Active, unrestricted Registered Nurse (RN) license in the state of practice.
A bachelor's degree in a health care-related field may be required in some states, depending on state or contractual requirements.
Valid, unrestricted driver's license, reliable transportation, and adequate auto insurance for job-related travel, unless otherwise required by law.
Ability to work proactively and with attention to detail.
Knowledge of community resources.
Ability to work in varied settings and adapt working style when serving diverse populations and people with different personalities and circumstances.
Ability to work independently with minimal supervision and demonstrate self-motivation.
Responsiveness across communication channels and ability to remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Time-management and prioritization skills, ability to manage multiple projects simultaneously, and adaptability to change.
Problem-solving skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office and applicable software programs.
In some states, at least 1 year of experience working directly with individuals with substance use disorders is required.

Nice To Haves

Certified Case Manager (CCM).
Experience working with populations that receive waiver services.

Responsibilities

Complete comprehensive member assessments within regulated timelines, including in-person home visits when required.
Facilitate comprehensive waiver enrollment and disenrollment processes.
Develop and implement care plans, including waiver service plans, in collaboration with members, caregivers, physicians, other health care professionals, and member support networks.
Monitor care plans on an ongoing basis, evaluate effectiveness, document interventions and goal achievement, and recommend changes as appropriate.
Promote integration of behavioral health care, LTSS, and home and community resources to enhance continuity of care.
Assess medical necessity and authorize appropriate waiver services.
Evaluate covered benefits and advise members regarding funding sources.
Facilitate interdisciplinary care team meetings for service approvals or denials and informal team collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Assess barriers to care and coordinate assistance for psychosocial, financial, and medical concerns.
Identify critical incidents and develop prevention plans to protect member health and welfare.
Provide consultation, resources, and recommendations to peers as needed.
Manage complex member cases and medication regimens when assigned as a care manager RN.
Conduct medication reconciliation as needed.
Travel locally, estimated at 25–40%, when required by state or contractual requirements.