Care Manager, LTSS (RN) (must reside in Michigan)

Molina Healthcare•Long Beach, MI

About The Position

The Care Manager, LTSS (RN) supports long-term services and supports (LTSS)-specific care management and coordination activities for the Michigan health plan. The role collaborates with a multidisciplinary team to coordinate integrated care across the continuum for members with high-need potential, support progress toward desired outcomes, and contribute to quality and cost-effective member care. The position requires residence in Michigan and may involve an estimated 25–40% local travel, depending on state and contractual requirements. The Care Manager conducts comprehensive assessments, including in-person home visits when required; supports waiver enrollment and disenrollment; and develops and monitors care plans, including waiver service plans, with members, caregivers, clinicians, and support networks. The role coordinates LTSS, behavioral health care, and community resources, assesses medical necessity, authorizes appropriate waiver services, and helps members address barriers to care. RN care managers may handle complex cases and medication regimens and may conduct medication reconciliation.

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 accepted.
Active, unrestricted Registered Nurse (RN) license in the state of practice.
Must reside in Michigan.
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 adjust approach when working with diverse populations, personalities, and personal situations.
Ability to work independently with minimal supervision and demonstrate self-motivation.
Responsive communication 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, and adaptability to change.
Problem-solving skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office and applicable software programs.
In some states, a bachelor's degree in a health care-related field may be required, depending on state or contractual requirements.
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 as 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 to 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 appropriately regarding funding sources.
Facilitate interdisciplinary care team (ICT) meetings for service approvals or denials and support informal ICT collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Assess barriers to care and coordinate assistance for members facing psychosocial, financial, or medical obstacles.
Identify critical incidents and develop prevention plans to support member health and welfare.
Provide consultation, resources, and recommendations to peers as needed.
Manage complex member cases and medication regimens as assigned to RN care managers.
Conduct medication reconciliation as needed.