Care Manager, LTSS (RN)

Molina Healthcare•Madison, IL

7d•$28 - $54

About The Position

The Care Manager, LTSS (RN) provides support for care management and care coordination activities specific to long-term services and supports (LTSS). The role collaborates with a multidisciplinary team to coordinate integrated member care across the continuum, particularly for members with high-need potential. It aims to support members in progressing toward desired outcomes and contribute to quality, cost-effective care. The Care Manager completes assessments and care planning, coordinates waiver enrollment and services, monitors member outcomes, and integrates behavioral health, LTSS, and community resources. The role also addresses barriers to care, supports member health and welfare, and may manage complex cases and medication regimens. 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, or LTSS; an equivalent combination of relevant education and experience is also accepted.
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 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 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 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 as required.
Facilitate comprehensive waiver enrollment and disenrollment processes.
Develop and implement care plans, including waiver service plans, with members, caregivers, physicians, other health professionals, and the member's support network.
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 about appropriate funding sources.
Facilitate interdisciplinary care team (ICT) meetings for service approvals or denials 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.
Manage complex member cases and medication regimens when assigned.
Conduct medication reconciliation as needed.