Molina Healthcare
Overview
Care Manager, LTSS (RN) at Molina Healthcare. This role requires an RN with an active unrestricted license in the state of MI. The position involves field work, travel to member homes, and coordination of long-term services and supports for high-need members in the Medicaid/Medicare population. Responsibilities
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 other health care professionals to address member needs and goals. Performs ongoing monitoring of care plans 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 connects members with home and community resources to enhance continuity of care. Assesses medical necessity and authorizes appropriate waiver services. Evaluates covered benefits and advises regarding funding sources as appropriate. 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 address psycho/social, financial, and medical obstacles. 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. Travel up to 25-40% estimated locally (may vary by state/contractual requirements) and field visits as needed. Qualifications
At least 2 years of experience in health care, including at least 1 year in care management, managed care, or a medical/behavioral health setting, and at least 1 year of experience with persons with disabilities, chronic conditions, substance use disorders, and LTSS, or equivalent combination of relevant education and experience. Registered Nurse (RN) with an active, unrestricted license in the state of practice (Michigan). Valid driver's license, reliable transportation, and adequate auto insurance for job-related travel requirements, unless otherwise required by law. Ability to operate proactively and perform detail-oriented work. Demonstrated knowledge of community resources. Ability to work in diverse settings with various populations and personal circumstances. Ability to work independently with minimal supervision and demonstrate self-motivation. Strong communication skills and responsiveness in all forms of communication; able to remain calm in high-pressure situations. Ability to develop and maintain professional relationships. Excellent time-management, prioritization, and ability to manage multiple projects and adapt to change. Excellent problem-solving and critical-thinking skills. Proficiency with Microsoft Office and applicable software programs. In some states, at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications
Certified Case Manager (CCM). Experience working with populations that receive waiver services. Additional Details
Travel in the field to do member visits may be required in the surrounding areas (Detroit, MI). Travel will be up to 50% of the time where applicable; mileage is reimbursed. Schedule: Monday through Friday, 8:30 AM to 5:00 PM EST (no weekends or holidays). Pay Range: $26.41 - $51.49 / HOURLY. Actual compensation may vary based on geographic location, work experience, education and/or skill level. 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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Care Manager, LTSS (RN) at Molina Healthcare. This role requires an RN with an active unrestricted license in the state of MI. The position involves field work, travel to member homes, and coordination of long-term services and supports for high-need members in the Medicaid/Medicare population. Responsibilities
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 other health care professionals to address member needs and goals. Performs ongoing monitoring of care plans 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 connects members with home and community resources to enhance continuity of care. Assesses medical necessity and authorizes appropriate waiver services. Evaluates covered benefits and advises regarding funding sources as appropriate. 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 address psycho/social, financial, and medical obstacles. 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. Travel up to 25-40% estimated locally (may vary by state/contractual requirements) and field visits as needed. Qualifications
At least 2 years of experience in health care, including at least 1 year in care management, managed care, or a medical/behavioral health setting, and at least 1 year of experience with persons with disabilities, chronic conditions, substance use disorders, and LTSS, or equivalent combination of relevant education and experience. Registered Nurse (RN) with an active, unrestricted license in the state of practice (Michigan). Valid driver's license, reliable transportation, and adequate auto insurance for job-related travel requirements, unless otherwise required by law. Ability to operate proactively and perform detail-oriented work. Demonstrated knowledge of community resources. Ability to work in diverse settings with various populations and personal circumstances. Ability to work independently with minimal supervision and demonstrate self-motivation. Strong communication skills and responsiveness in all forms of communication; able to remain calm in high-pressure situations. Ability to develop and maintain professional relationships. Excellent time-management, prioritization, and ability to manage multiple projects and adapt to change. Excellent problem-solving and critical-thinking skills. Proficiency with Microsoft Office and applicable software programs. In some states, at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications
Certified Case Manager (CCM). Experience working with populations that receive waiver services. Additional Details
Travel in the field to do member visits may be required in the surrounding areas (Detroit, MI). Travel will be up to 50% of the time where applicable; mileage is reimbursed. Schedule: Monday through Friday, 8:30 AM to 5:00 PM EST (no weekends or holidays). Pay Range: $26.41 - $51.49 / HOURLY. Actual compensation may vary based on geographic location, work experience, education and/or skill level. 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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