Telephonic Complex Case Care Manager, LTSS (RN) - MUST Reside in Texas

Job Description

Opportunity for a TX licensed RN, residing in Texas, with experience functioning
as a Care Manager working with Complex/Intensive cases.  Telephonically you will
complete assessments needed for determining the types of services we need to
provide and managing their care until they are discharged from your service. The
ideal candidate will have experience as a Case Manager within a managed care
organization (MCO) like Molina, but we also consider RNs with a strong
background in complex cases. Hours are Monday – Friday, 8 AM – 5 PM CST working
from home. 

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. Excellent computer
skills and attention to detail are very important to multitask between systems
and talking with members on the phone while entering accurate contact notes.
This is a fast-paced position and productivity is important.

Job Summary

Provides support for care management/care coordination long-term services and
supports (LTSS)-specific activities.  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,

• Facilitates comprehensive waiver enrollment and disenrollment processes.

• Develops and implements care plans, including a waiver service plan in

• Performs ongoing monitoring of care plan to evaluate effectiveness, document

• Promotes integration of services for members including behavioral health care

• Assesses for medical necessity and authorizes all appropriate waiver services.

• Evaluates covered benefits and advises appropriately regarding funding

• Facilitates interdisciplinary care team (ICT) meetings for approval or denial

• Uses motivational interviewing and Molina clinical guideposts to educate,

• Assesses for barriers to care and provides care coordination and assistance to

• Identifies critical incidents and develops prevention plans to assure member

• 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

Required Qualifications

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

• Registered Nurse (RN). License must be active and unrestricted in state of

• In some states, a bachelor's degree in a health care related field may be

• Valid and unrestricted driver's license, reliable transportation, and adequate

• 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 -

• Ability to work independently, with minimal supervision and demonstrate

• Responsiveness in all forms of communication, and ability to remain calm in

• Ability to develop and maintain professional relationships.

• Time-management and prioritization skills, and ability to focus on multiple

• Problem-solving 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

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