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Case Manager, LTSS (RN) ILLINOIS
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Job Description Job Summary Molina Healthcare Services (HCS) works with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high-need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
Knowledge/Skills/Abilities
Completes face-to-face comprehensive assessments of members per regulated timelines.
Facilitates comprehensive waiver enrollment and disenrollment processes.
Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician, and/or other appropriate healthcare professionals and support network to address needs and goals.
Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
Promotes integration of services including behavioral health and long-term services and supports, home and community care to enhance continuity.
Assesses for medical necessity and authorizes appropriate waiver services.
Evaluates covered benefits and advises on funding sources.
Conducts face-to-face or home visits as required.
Facilitates interdisciplinary care team meetings for service approval or denial.
Uses motivational interviewing and Molina clinical guideposts to educate, support, and motivate members.
Assesses barriers to care, provides care coordination, and assists members with psycho/social, financial, and medical obstacles.
Identifies critical incidents and develops prevention plans.
Provides consultation, recommendations, and education to non-RN case managers.
Works with members with complex medical conditions and medication regimens.
Conducts medication reconciliation when needed.
Travel required: 50-75%.
Job Qualifications Required Education Graduate from an accredited School of Nursing.
Required Experience
At least 1 year working with persons with disabilities/chronic conditions and Long Term Services & Supports.
1-3 years in case management, disease management, managed care, or behavioral health settings.
Active, unrestricted State RN license in good standing.
Valid driver's license with good record and reliable transportation if field work is required.
State Specific Requirements Must be licensed in Illinois.
Preferred Education Bachelor's Degree in Nursing.
Preferred Experience
3-5 years in relevant settings.
Experience with waiver services.
Preferred License Active and unrestricted CCM certification.
Additional Information Position involves 50-75% travel. Salary range: $27.73 - $54.06/hour. Benefits and compensation are competitive. Equal Opportunity Employer.
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Case Manager, LTSS (RN) ILLINOIS
role at
ClickJobs.io
Get AI-powered advice on this job and more exclusive features.
Job Description Job Summary Molina Healthcare Services (HCS) works with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high-need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
Knowledge/Skills/Abilities
Completes face-to-face comprehensive assessments of members per regulated timelines.
Facilitates comprehensive waiver enrollment and disenrollment processes.
Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician, and/or other appropriate healthcare professionals and support network to address needs and goals.
Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
Promotes integration of services including behavioral health and long-term services and supports, home and community care to enhance continuity.
Assesses for medical necessity and authorizes appropriate waiver services.
Evaluates covered benefits and advises on funding sources.
Conducts face-to-face or home visits as required.
Facilitates interdisciplinary care team meetings for service approval or denial.
Uses motivational interviewing and Molina clinical guideposts to educate, support, and motivate members.
Assesses barriers to care, provides care coordination, and assists members with psycho/social, financial, and medical obstacles.
Identifies critical incidents and develops prevention plans.
Provides consultation, recommendations, and education to non-RN case managers.
Works with members with complex medical conditions and medication regimens.
Conducts medication reconciliation when needed.
Travel required: 50-75%.
Job Qualifications Required Education Graduate from an accredited School of Nursing.
Required Experience
At least 1 year working with persons with disabilities/chronic conditions and Long Term Services & Supports.
1-3 years in case management, disease management, managed care, or behavioral health settings.
Active, unrestricted State RN license in good standing.
Valid driver's license with good record and reliable transportation if field work is required.
State Specific Requirements Must be licensed in Illinois.
Preferred Education Bachelor's Degree in Nursing.
Preferred Experience
3-5 years in relevant settings.
Experience with waiver services.
Preferred License Active and unrestricted CCM certification.
Additional Information Position involves 50-75% travel. Salary range: $27.73 - $54.06/hour. Benefits and compensation are competitive. Equal Opportunity Employer.
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