Care Manager, LTSS (RN)

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 ensure members progress toward desired outcomes and contributes to the strategy of providing quality, cost-effective care. The position includes completing comprehensive assessments within regulated timelines, including required in-person home visits; facilitating waiver enrollment and disenrollment; and developing, implementing, and monitoring care plans and waiver service plans in collaboration with members, caregivers, physicians, other health care professionals, and the member’s support network. The Care Manager coordinates behavioral health, LTSS, and community resources, assesses medical necessity, authorizes appropriate waiver services, evaluates covered benefits and funding sources, and facilitates interdisciplinary care team meetings. The role also involves educating and supporting members through motivational interviewing and clinical guideposts; identifying and addressing barriers to care; identifying critical incidents and developing prevention plans; and, for RN care managers, potentially handling complex cases and medication regimens and conducting medication reconciliation. Local travel of approximately 25–40% may be required, 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, or a medical or behavioral health setting, and at least 1 year working with persons with disabilities, chronic conditions, substance abuse disorders, or LTSS; an equivalent combination of relevant education and experience may qualify.
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.
Demonstrated knowledge of community resources.
Ability to work in varied settings and adapt work style when serving diverse populations and addressing varied personalities and personal situations.
Ability to work independently with minimal supervision and demonstrate self-motivation.
Responsiveness in all forms of 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, health care professionals, and the member’s support network.
Monitor care plans, 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 approval or denial and informal collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Assess barriers to care and coordinate assistance addressing psychosocial, financial, and medical concerns.
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.
Travel locally approximately 25–40% when required by state or contractual requirements.