Care Manager, LTSS (RN) (Field travel in Milwaukee County, WI)
Provides support for care management/care coordination services for long‑term services and supports (LTSS). Collaborates with multidisciplinary teams to coordinate 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.
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 health‑care professionals and member support network 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 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.
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.
Estimated 25‑40% local travel may be required based on state/contractual requirements.
Required Qualifications
At least 2 years experience in health care, including at least 1 year in care management, managed care, or a medical or behavioral health setting, and at least 1 year working with persons with disabilities, chronic conditions, substance abuse disorders, and LTSS, or equivalent combination of education and experience.
Registered Nurse (RN) with an active and unrestricted license in the state of practice.
Valid and unrestricted driver’s license, reliable transportation, and adequate auto insurance for job‑related travel requirements.
Proactive, detail‑oriented work style.
Knowledge of community resources.
Ability to work independently with minimal supervision and maintain self‑motivation.
Strong communication skills and ability to remain calm in high‑pressure situations.
Professional relationship‑building skills.
Excellent time‑management and prioritization skills.
Strong problem‑solving and critical‑thinking abilities.
Strong verbal and written communication skills.
Proficiency in Microsoft Office suite.
In some states, at least 1 year of experience working directly with individuals with substance use disorders.
Preferred Qualifications
Certified Case Manager (CCM).
Experience working with populations receiving waiver services.
Molina Healthcare offers a competitive benefits and compensation package.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $26.41 - $51.49 / HOURLY
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.