Phone Queue Care Manager, LTSS (RN) - Must Reside inTexas

JOB DESCRIPTION

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Opportunity for a Texas

licensed RN to support our Medicaid Members telephonically as part

of the Member Outreach Team. Three days a week the members of this

team utilize an auto-dialer system to make outbound calls to waiver

members to follow up on the services needed and address any

barriers. The remaining days, you will participate in the

department’s inbound call queue taking calls from members who have

phoned in for assistance. Hours are M – F, 8 AM – 5

PM.

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Preferred experience

includes Home Health, Care Management either at another MCO like

Molina or within a hospital. Candidates should be familiar with

different types of DME as well.  Additional experience working

in a phone queue is an added bonus!

Solid experience with Microsoft Office Suite

is necessary, especially with Outlook, Excel, and Teams as well as

being confident in moving between different programs to complete

the necessary forms and documentation.

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 member's support network

to address the member 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 for members including behavioral health

care and long term services and supports, home and community to

enhance the continuity of care for Molina members.

Assesses for medical necessity and authorize all

appropriate waiver services.

Evaluates covered

benefits and advise appropriately regarding funding

source.

Conducts face-to-face or home visits

as required.

Facilitates interdisciplinary

care team 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, provides care coordination

and assistance to member to address psycho / social, financial, and

medical obstacles concerns.

Identifies

critical incidents and develops prevention plans to assure member's

health and welfare.

Provides consultation,

recommendations and education as appropriate to non-RN case

managers

Works cases with members who have

complex medical conditions and medication regimens

Conducts medication reconciliation when

needed.

• 50-75% travel required.

JOB

QUALIFICATIONS

Required

Education

Graduate from an Accredited

School of Nursing

Required

Experience

At least 1 year

of experience working with persons with disabilities / chronic

conditions and Long Term Services & Supports.

1-3 years in case management, disease management, managed

care or medical or behavioral health settings.

Active, unrestricted State Registered Nursing license

(RN) in good standing

If field work is

required, Must have valid driver's license with good driving record

and be able to drive within applicable state or locality with

reliable transportation.

State Specific Requirements

Virginia : Must have at least one year of experience

working directly with individuals with Substance Use

Disorders

Preferred

Education

Bachelor's Degree in

Nursing

Preferred

Experience

3-5 years in

case management, disease management, managed care or medical or

behavioral health settings.

1 year experience

working with population who receive waiver services.

Preferred License, Certification,

Association

Active and unrestricted

Certified Case Manager (CCM)

To all current Molina employees : If you are interested in

applying for this position, please apply through the intranet job

listing.

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

from posting based on geographic location, work experience,

education and / or skill level.