Field Care Manager, LTSS (RN) - LOCAL TRAVEL REQUIRED

Molina Healthcare•Long Beach, TX

About The Position

Molina is hiring a Texas-licensed Registered Nurse as a Field Care Manager to support Medicaid members in the El Paso, Texas area. The role provides 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 help members progress toward desired outcomes while supporting quality and cost-effective care. The position includes completing assessments to determine waiver-service eligibility, developing and monitoring care plans and waiver service plans, coordinating waiver enrollment and disenrollment, assessing medical necessity, and authorizing appropriate waiver services. The role also supports service integration, interdisciplinary care team collaboration, member education and motivation, and identification of barriers and critical incidents. In-person home visits may be required. Local travel is estimated at 25–40%, and mileage is reimbursed. Candidates must live within 30–45 minutes of the coverage area. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. Central Time.

Requirements

Registered Nurse (RN) with an active, unrestricted license in the state of practice; this position serves Texas members.
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 acceptable.
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.
Demonstrated knowledge of community resources.
Ability to work in varied settings and adapt 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 adaptability to change.
Problem-solving skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office and applicable software, especially Outlook, Excel, OneNote, and Teams, and confidence switching between programs to complete forms and documentation.
Must live within 30–45 minutes of the coverage area.
Able to meet local travel requirements, estimated at 25–40%.

Nice To Haves

Certified Case Manager (CCM).
Experience working with populations that receive waiver services.
Previous experience working with the Medicaid population within a Managed Care Organization (MCO).
In some states, at least one year of experience working directly with individuals with substance use disorders.

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 health professionals, and the member’s support network.
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 appropriate funding sources.
Facilitate interdisciplinary care team meetings for service approval or denial and support informal ICT collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Identify barriers to care and provide coordination and assistance addressing psychosocial, financial, and medical concerns.
Identify critical incidents and develop prevention plans to support 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.