Care Manager, LTSS (RN) - Field travel to Jefferson and DaneCounties, WI

Jefferson (85%) and Dane (15%) Counties, WI for member

visits

JOB

DESCRIPTION Job Summary

Provides support for

care management / care coordination long-term services and supports

specific activities and collaborates with multidisciplinary team

coordinating 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

appropriate health care professionals and member support network to

address the member needs and goals.

• Performs ongoing

monitoring of 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 (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

concerns.

• 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.

• 25-40%

estimated local travel may be required (based upon

state / contractual

requirements).

Required Qualifications

• At

least 2 years experience in health care, including at least 1 year

experience in care management, managed care, and / or experience in a

medical or behavioral health setting, and at least 1 year of

experience working with persons with disabilities, chronic

conditions, substance abuse disorders, and long-term services and

supports (LTSS), or equivalent combination of relevant education

and experience.

• Registered Nurse (RN). License must be

active and unrestricted in state of practice.

• Valid and

unrestricted driver's license, reliable transportation, and

adequate auto insurance for job related travel requirements, unless

otherwise required by law.

• Ability to operate

proactively and demonstrate detail-oriented work.

Demonstrated knowledge of community resources.

• Ability

to work within a variety of settings and adjust style as needed -

working with diverse populations and various personalities and

personal situations.

• Ability to work independently,

with minimal supervision and demonstrate

self-motivation.

• Responsiveness in all forms of

communication, and ability to remain calm in high-pressure

situations.

• Ability to develop and maintain

professional relationships.

• Excellent time-management

and prioritization skills, and ability to focus on multiple

projects simultaneously and adapt to change.

• Excellent

problem-solving and critical-thinking skills.

• Strong

verbal and written communication skills.

• Microsoft

Office suite / applicable software program(s)

proficiency.

• In some states, must have 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.

To

all current Molina employees : If you are interested in applying for

this position, please apply through the Internal Job

Board.

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.