Care Manager, LTSS (RN)

Molina Healthcare•Waltham, MA

3d•$30 - $59

About The Position

Provides support for long-term services and supports (LTSS)-specific care management and care coordination activities. Collaborates with a multidisciplinary team to coordinate integrated member care across the continuum for members with high-need potential. Works to ensure members progress toward desired outcomes and contributes to the strategy of providing quality, cost-effective care. The role may involve complex member cases and medication regimens, medication reconciliation, and an estimated 25–40% local travel, depending on state and contractual requirements.

Requirements

At least 2 years of health care experience, including at least 1 year in care management, managed care, and/or a medical or behavioral health setting, and at least 1 year working with persons with disabilities, chronic conditions, substance abuse disorders, and LTSS; an equivalent combination of relevant education and experience is acceptable.
Active, unrestricted Registered Nurse (RN) license in the state of practice.
In some states, a bachelor's degree in a health care-related field may be required, 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.
Demonstrated 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 simultaneously, and adaptability to change.
Problem-solving skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office suite and applicable software programs.
In some states, at least one 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.
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 (ICT) meetings for service approval or denial and informal ICT collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Assess barriers to care and coordinate care and assistance addressing psychosocial, financial, and medical concerns.
Identify critical incidents and develop prevention plans to assure member health and welfare.
Provide consultation, resources, and recommendations to peers as needed.
For RN care managers, manage assigned complex member cases and medication regimens and conduct medication reconciliation as needed.