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. Strives to ensure members progress toward desired outcomes and contributes to the strategy of providing quality, cost-effective care. The role includes completing comprehensive member assessments within regulated timelines, including in-person home visits when required; facilitating waiver enrollment and disenrollment; developing and monitoring care plans and waiver service plans with members, caregivers, physicians, other health professionals, and support networks; assessing medical necessity and authorizing appropriate waiver services; and coordinating behavioral health, LTSS, and community resources. The Care Manager also facilitates interdisciplinary care team meetings, uses motivational interviewing to educate and support members, addresses barriers to care, and identifies critical incidents and prevention plans. RN Care Managers may handle complex cases and medication regimens and conduct medication reconciliation as needed. Local travel of approximately 25–40% may be required, depending on state and contractual requirements.

Requirements

Registered Nurse (RN) with an active, unrestricted license in the state of practice.
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 may qualify.
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 working style 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 focus on multiple projects simultaneously, and adaptability to change.
Problem-solving skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office suite or 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 professionals, and member support networks.
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 support informal team collaboration.
Use motivational interviewing and clinical guideposts to educate, support, and motivate members during contacts.
Assess barriers to care and coordinate assistance with 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.
For RN Care Managers, manage complex member cases and medication regimens and conduct medication reconciliation as needed.
Travel locally as required, estimated at 25–40% based on state and contractual requirements.