Care Manager, LTSS (RN)

Molina Healthcare Downers Grove, IL 60515, US

$23.76 - $51.49 / hour

JOB DESCRIPTION Job Summary

Provides support for care management/care coordination long-term services and supports (LTSS)-specific activities. 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.

Essential Job Duties

• 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).

Required Qualifications

• At least 2 years of 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.

• In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).

• 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.

• Time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.

• Problem-solving 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.

Preferred Qualifications

• Certified Case Manager (CCM).

• Experience working with populations that receive waiver services.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $23.76 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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