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

Molina Healthcare•Long Beach, TX

2d•Onsite

About The Position

Molina is seeking a Texas-licensed Registered Nurse to work as a Field Care Manager with Medicaid members in the Mission, Texas service delivery area. The position 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 needs. The role focuses on helping members progress toward desired outcomes while contributing to quality, cost-effective care. Candidates who live within 20 minutes of Mission are preferred, as are candidates with experience serving Medicaid members within a Managed Care Organization. Local travel is estimated at 25–40% and mileage is reimbursed as part of the benefits package. The Field Care Manager completes assessments used to determine waiver-service eligibility, including in-person home visits when required. The role coordinates waiver enrollment and disenrollment, develops and monitors care plans and waiver service plans with members and their support networks, assesses medical necessity, and authorizes appropriate waiver services. It also promotes coordination across behavioral health, LTSS, and community resources; facilitates interdisciplinary care team processes; and helps members address barriers to care. Care Manager RNs may be assigned complex cases and medication regimens and may conduct medication reconciliation. The schedule is Monday through Friday, 8:00 AM–5:00 PM Central Time. The role requires proficiency with Microsoft Office, particularly Outlook, Excel, and Teams, and the ability to move between software programs to complete forms and documentation. Molina Healthcare offers a competitive benefits and compensation package and is an Equal Opportunity Employer.

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 may qualify.
Active, unrestricted Registered Nurse (RN) license in the state of practice.
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.
Knowledge of community resources.
Ability to adapt working style across settings and work 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 programs.
In some states, at least 1 year of experience working directly with individuals with substance use disorders may be required.
In some states, a bachelor's degree in a health care-related field may be required, depending on state or contractual requirements.

Nice To Haves

Certified Case Manager (CCM).
Experience working with populations that receive waiver services.
Residence within 20 minutes of Mission, Texas.
Experience working with the Medicaid population within a Managed Care Organization.

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, in collaboration with members, caregivers, physicians, other health care professionals, and the member's support network.
Monitor care plans, evaluate their effectiveness, document interventions and goal achievement, and recommend changes.
Promote integration of behavioral health care, LTSS, and home and community resources to support 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 support informal interdisciplinary collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Assess barriers to care and provide coordination 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.