Care Manager, LTSS (RN) at Molina Healthcare
United States
<p><strong>This is a remote field-based role requiring travel.</strong></p> <p><strong>Job Summary</strong></p> <p>Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.<br><br> <strong>Essential Job Duties</strong></p> <p>• Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.<br> • Facilitates comprehensive waiver enrollment and disenrollment processes.<br> • 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.<br> • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.<br> • 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.<br> • Assesses for medical necessity and authorizes all appropriate waiver services.<br> • Evaluates covered benefits and advises appropriately regarding funding sources.<br> • Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration.<br> • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.<br> • Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns.<br> • Identifies critical incidents and develops prevention plans to assure member health and welfare.<br> • May provide consultation, resources and recommendations to peers as needed.<br> • Care manager RNs may be assigned complex member cases and medication regimens.<br> • Care manager RNs may conduct medication reconciliation as needed.<br> • 25-40% estimated local travel may be required (based upon state/contractual requirements).<br><br> <strong>Required Qualifications</strong></p> <p>• 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.<br> • Registered Nurse (RN). License must be active and unrestricted in state of practice.<br> • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.<br> • Ability to operate proactively and demonstrate detail-oriented work.<br> • Demonstrated knowledge of community resources.<br> • Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations.<br> • Ability to work independently, with minimal supervision and demonstrate self-motivation.<br> • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations.<br> • Ability to develop and maintain professional relationships.<br> • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.<br> • Excellent problem-solving and critical-thinking skills.<br> • Strong verbal and written communication skills.<br> • Microsoft Office suite/applicable software program(s) proficiency.<br> • In some states, must have at least one year of experience working directly with individuals with substance use disorders.<br><br> <strong>Preferred Qualifications</strong></p> <p><br> • Certified Case Manager (CCM).<br> • Experience working with populations that receive waiver services.<br><br> To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.<br><br> Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V</p>
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