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

Molina Healthcare•Long Beach, CA

About The Position

The Field Care Manager 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 care across the continuum for members with high-need potential, support progress toward desired outcomes, and contribute to quality, cost-effective member care. The position serves Medicaid members in the Tyler, Texas service delivery area and requires a Texas RN license. Local travel is estimated at 25–40%, including in-person home visits as required; candidates must live within 30–45 minutes of the coverage area. Mileage is reimbursed. The schedule is Monday through Friday, 8 AM to 5 PM CST. The Field Care Manager completes assessments to determine members’ eligibility for services, develops and monitors care plans, coordinates waiver services and community resources, and supports members in addressing barriers to care. The role may involve complex member cases and medication regimens, medication reconciliation, and consultation to peers.

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.
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 work-related travel, unless otherwise required by law.
Proactive, detail-oriented approach to work.
Knowledge of community resources.
Ability to work in varied settings and adapt work style to diverse populations, personalities, and personal situations.
Ability to work independently with minimal supervision and demonstrate self-motivation.
Responsive communication skills and ability to remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Time-management and prioritization skills, ability to focus on multiple projects, and adaptability to change.
Problem-solving skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office and applicable software, particularly Outlook, Excel, OneNote, and Teams, including confidence toggling 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.

Nice To Haves

Certified Case Manager (CCM).
Experience working with populations that receive waiver services.
Experience working with the Medicaid population within a Managed Care Organization (MCO); preference is given to candidates with this experience.

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, evaluate effectiveness, document interventions and goal achievement, and suggest 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 meetings for service approval or denial and informal team 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.
Handle assigned complex member cases and medication regimens as applicable.
Conduct medication reconciliation as needed.