Care Manager, LTSS (RN)

Molina Healthcare•Madison, WI

5d•$26 - $51•Remote

About The Position

The Care Manager, LTSS (RN) provides support for long-term services and supports (LTSS)-specific care management and care coordination activities. The role collaborates with a multidisciplinary team to coordinate integrated member care across the continuum, particularly for members with high-need potential, and supports progress toward desired outcomes while contributing to quality and cost-effective care. The position conducts comprehensive assessments, develops and monitors care plans and waiver service plans, coordinates waiver enrollment and disenrollment, and promotes integration of behavioral health, LTSS, and community resources. It assesses medical necessity, authorizes appropriate waiver services, evaluates covered benefits and potential funding sources, and facilitates interdisciplinary care team meetings. The Care Manager uses motivational interviewing to educate and support members, addresses barriers to care, identifies critical incidents, and develops prevention plans. RN care managers may handle complex cases and medication regimens and conduct medication reconciliation as needed. The role is remote, with member visits and an estimated 25–40% local travel throughout Dane, Dodge, Jefferson, and Rock Counties, Wisconsin, subject to 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 people with disabilities, chronic conditions, substance abuse disorders, and LTSS; an equivalent combination of relevant education and experience is acceptable.
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.
Knowledge of community resources.
Ability to work in varied settings and adapt 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, ability to manage multiple projects simultaneously, and adaptability to change.
Problem-solving skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office 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 required in-person home visits.
Facilitate comprehensive waiver enrollment and disenrollment processes.
Develop and implement care plans, including waiver service plans, in collaboration 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 about funding sources.
Facilitate interdisciplinary care team meetings for service approval or denial 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.
Identify critical incidents and develop prevention plans to protect member health and welfare.
Provide consultation, resources, and recommendations to peers as needed.
Handle complex member cases and medication regimens when assigned as a care manager RN.
Conduct medication reconciliation as needed.