Care Manager, LTSS (RN) (Field travel in Racine / KenoshaCounty, WI)

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.

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.

Required License, Certification,

Association

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.

#PJHS

#HTF

Pay Range : $26.41 - $51.49 /

HOURLY

on geographic location, work experience, education and / or skill

level.