Care Manager, LTSS (RN)

Molina Healthcare•Long Beach, WI

1d•Remote

About The Position

The Care Manager, LTSS provides support for long-term services and supports (LTSS)-specific care management and coordination activities. The role collaborates with a multidisciplinary team to coordinate integrated care across the continuum for members with high-need potential, supporting progress toward desired outcomes and quality, cost-effective care. The position is remote, with member visits and an estimated 25–40% local travel throughout Pierce and St. Croix Counties, Wisconsin, as required by state or contractual requirements. The Care Manager completes member assessments, facilitates waiver enrollment and disenrollment, and develops and monitors care plans and waiver service plans in collaboration with members, caregivers, healthcare professionals, and support networks. The role coordinates behavioral health, LTSS, and community resources; assesses medical necessity; authorizes appropriate waiver services; advises on benefits and funding sources; and facilitates interdisciplinary care team meetings. It also uses motivational interviewing to support members, addresses barriers to care, identifies critical incidents and prevention measures, and may consult with peers. RN care managers may handle complex cases and medication regimens and conduct medication reconciliation as needed.

Requirements

Registered Nurse (RN) with an active, unrestricted license in the state of practice.
At least 2 years of healthcare 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.
A bachelor's degree in a healthcare-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 to diverse populations, 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 and adapt 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 healthcare 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 support continuity of care.
Assess medical necessity and authorize appropriate waiver services.
Evaluate covered benefits and advise members appropriately about 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 with psychosocial, financial, and medical obstacles or 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 as assigned to care manager RNs.
Conduct medication reconciliation as needed.
Travel locally for member visits, estimated at 25–40% as required by state or contractual requirements.