Care Manager, LTSS (RN)

Molina Healthcare · Waltham

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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.

 

• • 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).

• • 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.

• • 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

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