Field Care Manager, LTSS (LVN)

About This Role

This role involves providing support for care management and coordination of long-term services for members with high-needs potential. It focuses on ensuring members progress toward desired outcomes and contributing to quality, cost-effective care.

Responsibilities

• Complete comprehensive member assessments within regulated timelines, including in-person home visits.
• Facilitate comprehensive waiver enrollment and disenrollment processes.
• Develop and implement care plans, including waiver service plans, in collaboration with members, caregivers, physicians, healthcare professionals, and support networks.
• Perform ongoing monitoring of care plans to evaluate effectiveness, document interventions, and achieve goals.
• Promote integration of services for members, including behavioral health care, long-term services, supports (LTSS), and home and community resources.
• Assess for medical necessity and authorize all appropriate waiver services.
• Evaluate covered benefits and advise appropriately regarding funding sources.
• Facilitate interdisciplinary care team (ICT) meetings for approval or denial of services 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 for psycho-social, financial, and medical obstacles.
• Identify critical incidents and develop prevention plans to assure member health and welfare.
• Collaborate with licensed care managers/leadership as needed or required.

Requirements

• 2+ years health care experience
• 1+ year experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS)
• 1+ year experience in care management or medical/behavioral health setting
• Active and unrestricted LPN/LVN license in state of practice
• Valid and unrestricted driver's license with adequate auto insurance
• Demonstrated knowledge of community resources
• Microsoft Office suite/applicable software program proficiency (Outlook, Excel, Teams)

Qualifications

• At least 2 years of healthcare experience, including 1 year with persons with disabilities/chronic conditions (LTSS) and 1 year in care management or a medical/behavioral health setting.

Nice to Have

• Previous experience working with the Medicare population within a Managed Care Organization (MCO)
• Experience working with populations that receive waiver services
• Bachelor's degree in a health care related field

Skills

* Required skills

Benefits

Certifications