RN Care Manager, LTSS Remote with Field work in Boston, Dorchester Roxbury Mattapan MA

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.

This position will support our Senior Whole Health business. Senior Whole Health by Molina Healthcare (“SWH”) is a community-based health care organization with national operations support delivering government funded health plans for members who reside in Massachusetts. We are looking for Care Managers with a RN licensure and a back ground in care management. Candidates with a background supporting mental health, substance use, and Home-based experience are highly preferred. Experience with supporting the geriatric population highly preferred. Bilingual candidates that speak Cape Verdean Creole, Spanish, Vietnamese, Haitian Creole are encouraged to apply to support our diverse communities!

Work Hours : Monday - Friday 8 : 30am - 5 : 00pm EST

Remote position with field travel in Dorchester / Roxbury / Mattapan and up to 10 miles / 30 min commute from primary location depending on business needs

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

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

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.

#PJNurse

Pay Range : $30.37 - $59.21 / HOURLY