Filed Care Manager, LTSS (RN) - Local Travel Required

Molina Healthcare•Long Beach, TX

9d•Onsite

About The Position

Molina is seeking a Texas-licensed Registered Nurse to work as a Field Care Manager with Medicaid members in Houston, covering Houston Heights, Shady Acres, Timber Grove, and the Greater Fifth Ward. The role supports care management and care coordination activities specific to long-term services and supports (LTSS), collaborating with a multidisciplinary team to coordinate integrated care for members with high-need potential. The Care Manager works to advance member outcomes and support quality, cost-effective care. Candidates should live within 30–45 minutes of the coverage area. Mileage for required local travel is reimbursed as part of the benefits package. The position's hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. CST, with estimated local travel of 25–40%, depending on state and contractual requirements. The role involves completing assessments, supporting waiver enrollment and disenrollment, developing and monitoring care plans, coordinating services, assessing medical necessity, and assisting members with barriers to care. Care Manager RNs may be assigned complex cases and medication regimens and may conduct medication reconciliation as needed.

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 use disorders, and LTSS; an equivalent combination of relevant education and experience may qualify.
Active, unrestricted Registered Nurse (RN) license in the state of practice; the role requires Texas licensure.
Valid, unrestricted driver's license, reliable transportation, and adequate auto insurance for work-related travel, unless otherwise required by law.
Ability to work proactively and with attention to detail.
Demonstrated knowledge of community resources.
Ability to adapt to varied settings, 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, including 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; particularly Outlook, Excel, OneNote, and Teams, and confidence switching between programs to complete forms and documentation.
In some states, at least 1 year of experience working directly with individuals with substance use disorders is required.
Candidates must be within 30–45 minutes of the Houston coverage area.

Nice To Haves

Preference for previous experience working with Medicaid populations within a Managed Care Organization (MCO).
Certified Case Manager (CCM).
Experience working with populations receiving waiver services.
A bachelor's degree in a health care-related field may be required in some states, depending on state or contractual requirements.

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 member support networks.
Monitor care plans on an ongoing basis 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 approvals or denials and support 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 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.
Travel locally for work, estimated at 25–40% depending on state and contractual requirements.