Field Care Manager, LTSS (RN) - Local Travel Required - EastHouston

JOB DESCRIPTION

Opportunity for a Texas licensed RN to join

Molina to work with our Medicare members in the eastern side of the

Houston service delivery area. You will complete assessments needed

for determining the types of services they are eligible to receive.

Preference will be given to those candidates with previous

experience working with the Medicaid population within a Managed

Care Organization (MCO). Mileage is reimbursed as part of our

benefits package. Hours are Monday – Friday, 8 AM – 5 PM

CST.

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.