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

Opportunity for a Texas RN to join Molina as a Care Manager working with Medicaid members in the southern part of the Dallas, TX service delivery area. Communities serviced include Lancaster, Seagoville, Red Oak, and DeSoto.

About the Role

Provides support for care management and care coordination of long-term services and supports. Collaborates with a multidisciplinary team to coordinate integrated delivery of member care across the continuum for members with high-need potential. Ensures member progress toward desired outcomes and contributes to the strategy for quality, cost-effective member care.

Responsibilities

• 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 other appropriate health care professionals to address member needs and goals.
• Performs ongoing monitoring of care plans 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 to address psycho/social, financial, and medical obstacles.
• Identifies critical incidents and develops prevention plans to assure member health and welfare.
• May provide consultation, resources, and recommendations to peers as needed.
• May be assigned complex member cases and medication regimens; may conduct medication reconciliation as needed.
• 25-40% estimated local travel may be required (based upon state/contractual requirements).

Requirements

• At least 2 years of experience in health care, including at least 1 year of experience in care management, managed care, and/or experience in a medical or behavioral health setting.
• 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) with an active and unrestricted license in the 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.
• Bilingual (required).
• Solid experience with Microsoft Office Suite, especially Outlook, Excel, and Teams, and confidence in moving between different programs to complete necessary forms and documentation.
• 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.
• 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.

Schedule

Monday – Friday, 8 AM – 5 PM CST.

Pay

Pay Range: $26.41 - $51.49 per hour. Actual compensation may vary based on geographic location, work experience, education, and/or skill level.

Benefits

• Mileage reimbursement as part of the benefit package.