Care Manager, LTSS (RN)

Molina Healthcare•Chicago, IL

1d•$28 - $54

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, particularly for members with high-need potential. Works to ensure members progress toward desired outcomes and contributes to strategies for quality, cost-effective care. The role includes conducting comprehensive assessments, facilitating waiver enrollment and disenrollment, developing and monitoring care plans, coordinating services and resources, assessing medical necessity, and supporting members in addressing barriers to care. The position may involve complex cases and medication regimens, medication reconciliation, and 25–40% estimated local travel based on state or 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 people 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.
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 adapt working style when serving diverse populations and personal situations.
Ability to work independently with minimal supervision and demonstrate self-motivation.
Responsive communication skills 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 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, with members, caregivers, physicians, other appropriate 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 approval or denial and informal ICT collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate change during member contacts.
Identify barriers to care and coordinate care and assistance to address 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 care manager RNs, manage assigned complex member cases and medication regimens as applicable.
For care manager RNs, conduct medication reconciliation as needed.
Travel locally an estimated 25–40% as required by state or contractual requirements.