Telephonic Care Manager, LTSS (RN) - TX ONLY - Disease Management

Molina Healthcare•Long Beach, CA

11h•Hybrid

About The Position

This opportunity is for a Texas-licensed Registered Nurse (RN) residing in Texas, with experience as a Care Manager handling complex/intensive cases and assisting with Disease Management. The role involves telephonically completing assessments to determine necessary services and managing member care until discharge. Candidates should have experience as a Case Manager within a managed care organization (MCO) like Molina, or a strong background in complex cases. Priority is given to qualified RNs in El Paso, Hidalgo, Houston, or San Antonio. The position is Monday – Friday, 8 AM – 5 PM, working from home. Solid experience with Microsoft Office Suite (Outlook, Excel, Teams) and excellent computer skills are essential for multitasking between systems, documenting accurate contact notes, and maintaining productivity in a fast-paced environment. The role provides support for care management/care coordination long-term services and supports (LTSS) activities, collaborating with a multidisciplinary team to coordinate integrated delivery of care for high-need members. The goal is to ensure member progress toward desired outcomes and contribute to quality and cost-effective care.

Requirements

At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
Ability to operate proactively and demonstrate detail-oriented work.
Demonstrated knowledge of community resources.
Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various 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.
Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
Excellent problem-solving and critical-thinking skills.
Strong verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
In some states, must have at least one year of experience working directly with individuals with substance use disorders.

Nice To Haves

Certified Case Manager (CCM).
Experience working with populations that receive waiver services.

Responsibilities

Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
Facilitates comprehensive waiver enrollment and disenrollment processes.
Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals.
Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care.
Assesses for medical necessity and authorizes all appropriate waiver services.
Evaluates covered benefits and advises appropriately regarding funding sources.
Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration.
Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns.
Identifies critical incidents and develops prevention plans to assure member health and welfare.
May provide consultation, resources and recommendations to peers as needed.
Care manager RNs may be assigned complex member cases and medication regimens.
Care manager RNs may conduct medication reconciliation as needed.
25-40% estimated local travel may be required (based upon state/contractual requirements).