Care Manager, LTSS (RN)

About This Role

The Care Manager, LTSS (RN) position at Molina Healthcare involves providing support for care management and coordination of long-term services for high-need members. This role focuses on completing comprehensive assessments, developing care plans, and ensuring the integrated delivery of member care across various services. The primary goal is to ensure member progress towards desired health outcomes efficiently and cost-effectively.

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, and other healthcare professionals
• Perform ongoing monitoring of care plans to evaluate effectiveness, document interventions, and achieve goals
• Promote integration of services for members, including behavioral health care and long-term services and supports (LTSS)
• Assess for medical necessity and authorize appropriate waiver services
• Evaluate covered benefits and provide advice regarding funding sources
• Facilitate interdisciplinary care team (ICT) meetings for service approval or denial and informal ICT collaboration
• Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate change during member contacts
• Assess for barriers to care and provide care coordination and assistance to members addressing psycho/social, financial, and medical obstacles

Requirements

• 2+ years experience in health care
• 1+ year experience in care management, managed care, and/or medical/behavioral health setting
• 1+ year experience working with persons with disabilities, chronic conditions, substance abuse disorders, and LTSS
• Active and unrestricted Registered Nurse (RN) license in Texas
• Valid and unrestricted driver's license with reliable transportation and adequate auto insurance
• Proficiency with Microsoft Office Suite (Outlook, Excel, Teams)
• Strong verbal and written communication skills
• Ability to work independently and manage time effectively

Qualifications

• 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.

Nice to Have

• Certified Case Manager (CCM)
• Experience working with populations that receive waiver services
• Experience working with the Medicare population within a Managed Care Organization (MCO)

Skills

* Required skills

Benefits