Care Manager, LTSS (RN)

Molina Healthcare•Columbus, OH

9d•$26 - $51

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 role includes conducting comprehensive assessments, coordinating waiver enrollment and services, developing and monitoring care plans, promoting integration of behavioral health, LTSS, and community resources, and supporting members in overcoming barriers to care. It also involves assessing medical necessity, facilitating interdisciplinary care team meetings, identifying critical incidents and prevention plans, and using motivational interviewing to support members. Care Manager RNs may handle complex cases and medication regimens and perform medication reconciliation as needed. Local travel of approximately 25–40% may be required 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, and LTSS, or an equivalent combination of relevant education and experience.
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.
Knowledge of community resources.
Ability to work in varied settings and adjust style when working with 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, with the 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 may be 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 care professionals, and the member’s support network.
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 about funding sources.
Facilitate interdisciplinary care team meetings for service approvals or denials and informal collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Assess barriers to care and provide coordination and assistance for 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.
Manage complex member cases and medication regimens as assigned.
Conduct medication reconciliation as needed.