Molina Healthcare
RN Care Manager, LTSS Field Care in Dorchester, Roxbury, Mattapan, Jamacia Plain
Molina Healthcare, Boston, Massachusetts, us, 02298
Overview
RN Care Manager, LTSS Field Care in Dorchester, Roxbury, Mattapan, Jamaica Plain, or South Boston Join to apply for the RN Care Manager, LTSS Field Care role at Molina Healthcare. 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. The Care Manager, LTSS provides support for care management/care coordination long-term services and supports, coordinating integrated delivery of member care across the continuum for members with high-need potential. The role supports our Senior Whole Health business and requires MA RN licensure and case management experience. Candidates should be organized, detail-oriented, computer proficient, and collaborative with the team. Bilingual candidates who speak Spanish, Haitian Creole, or Vietnamese (willing to use interpreters) are encouraged to apply to support our diverse communities. Work Hours: Monday - Friday 8:30am - 5:00pm EST. Remote with field travel up to 70% of the time within the Greater Boston Area (Dorchester, Roxbury, Mattapan, Jamaica Plain, South Boston). MA RN licensure required. 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 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 LTSS, and home and community resources to enhance continuity of care. Assesses 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 to address psycho/social, financial, and medical obstacles. Identifies critical incidents and develops prevention plans to ensure 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; 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 in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience with persons with disabilities, chronic conditions, substance abuse disorders, and LTSS, or equivalent combination of relevant education and experience. Registered Nurse (RN). Active and unrestricted license in state of practice. 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 to diverse populations and personalities. Ability to work independently with minimal supervision and demonstrate self-motivation. Responsive in all forms of communication and able to remain calm in high-pressure situations. Ability to develop and maintain professional relationships. Excellent time-management and prioritization skills, with ability to focus on multiple projects and adapt to change. Excellent problem-solving and critical-thinking skills. Strong verbal and written communication skills. Microsoft Office suite proficiency. In some states, at least one year of experience working directly with individuals with substance use disorders may be required. 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: $30.37 - $59.21 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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RN Care Manager, LTSS Field Care in Dorchester, Roxbury, Mattapan, Jamaica Plain, or South Boston Join to apply for the RN Care Manager, LTSS Field Care role at Molina Healthcare. 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. The Care Manager, LTSS provides support for care management/care coordination long-term services and supports, coordinating integrated delivery of member care across the continuum for members with high-need potential. The role supports our Senior Whole Health business and requires MA RN licensure and case management experience. Candidates should be organized, detail-oriented, computer proficient, and collaborative with the team. Bilingual candidates who speak Spanish, Haitian Creole, or Vietnamese (willing to use interpreters) are encouraged to apply to support our diverse communities. Work Hours: Monday - Friday 8:30am - 5:00pm EST. Remote with field travel up to 70% of the time within the Greater Boston Area (Dorchester, Roxbury, Mattapan, Jamaica Plain, South Boston). MA RN licensure required. 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 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 LTSS, and home and community resources to enhance continuity of care. Assesses 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 to address psycho/social, financial, and medical obstacles. Identifies critical incidents and develops prevention plans to ensure 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; 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 in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience with persons with disabilities, chronic conditions, substance abuse disorders, and LTSS, or equivalent combination of relevant education and experience. Registered Nurse (RN). Active and unrestricted license in state of practice. 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 to diverse populations and personalities. Ability to work independently with minimal supervision and demonstrate self-motivation. Responsive in all forms of communication and able to remain calm in high-pressure situations. Ability to develop and maintain professional relationships. Excellent time-management and prioritization skills, with ability to focus on multiple projects and adapt to change. Excellent problem-solving and critical-thinking skills. Strong verbal and written communication skills. Microsoft Office suite proficiency. In some states, at least one year of experience working directly with individuals with substance use disorders may be required. 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: $30.37 - $59.21 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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