Care Manager, LTSS (RN)

Molina Healthcare•Mount Vernon, IL

8d•$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 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 comprehensive member assessments, waiver enrollment and disenrollment, care planning and ongoing plan monitoring, service integration, medical-necessity assessments, waiver-service authorizations, benefits guidance, and interdisciplinary care team coordination. The care manager also 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. Local travel of approximately 25–40% may be required, depending on 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.
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 approach 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 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 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 when 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 the member’s support network.
Monitor care plans, evaluate their 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 (ICT) meetings for service approval or denial and informal ICT collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Assess barriers to care and coordinate care and assistance addressing 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.
Handle complex member cases and medication regimens as assigned to RN care managers.
Conduct medication reconciliation as needed.
Travel locally approximately 25–40% when required by state or contractual requirements.