RN- Care Manager, LTSS Field Care in Brockton (RN)
About the position
The Care Manager, LTSS 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.
This position will support our Molina Senior Care plan.
Molina Senior Care Plan
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 nurses with strong geriatric and chronic
disease management experience, comprehensive assessment, person-centered care
planning, and effective care coordination across interdisciplinary
teams. Familiarity with Medicare/Medicaid integration, LTSS, and SCO regulations
is a plus, Strong communication, documentation, EMR skills, and knowledge of
community resources. Cultural competence, time management, and the ability to
work independently. Previous SCO/ case management experience. Bilingual
candidates that speak
Cape Verdean Creole, Spanish, Haitian Creole are
encouraged to apply to support our diverse communities!
Responsibilities
• Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
• 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.
Requirements
• 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.
Nice-to-haves
• Certified Case Manager (CCM).
• Bilingual.
Benefits
• Molina Healthcare offers a competitive benefits and compensation package.
• Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
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Apply To this Job
The Care Manager, LTSS 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.
This position will support our Molina Senior Care plan.
Molina Senior Care Plan
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 nurses with strong geriatric and chronic
disease management experience, comprehensive assessment, person-centered care
planning, and effective care coordination across interdisciplinary
teams. Familiarity with Medicare/Medicaid integration, LTSS, and SCO regulations
is a plus, Strong communication, documentation, EMR skills, and knowledge of
community resources. Cultural competence, time management, and the ability to
work independently. Previous SCO/ case management experience. Bilingual
candidates that speak
Cape Verdean Creole, Spanish, Haitian Creole are
encouraged to apply to support our diverse communities!
Responsibilities
• Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
• 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.
Requirements
• 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.
Nice-to-haves
• Certified Case Manager (CCM).
• Bilingual.
Benefits
• Molina Healthcare offers a competitive benefits and compensation package.
• Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Apply tot his job
Apply To this Job