Telephonic Care Manager, LTSS (RN)

About the role

The role requires a Texas licensed RN with experience as a Care Manager, focusing on disease management and care coordination for complex cases.

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.
• 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 LTSS and home and community resources to enhance continuity of care.
• Affirms 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.
• 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 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.

Qualifications

• License to practice as a registered nurse in the state of Texas.
• Experience with Microsoft Office Suite, especially with Outlook, Excel, and Teams.
• Ability to multitask between systems and talk with members on the phone while entering accurate contact notes.
• Knowledge of community resources and ability to work with diverse populations.
• Ability to work independently and with minimal supervision.
• 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.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
• Experience working directly with individuals with substance use disorders in some states.

Skills

• Comprehensive member assessments.
• Collaboration with multidisciplinary teams.
• Development and implementation of care plans.
• Monitoring and evaluation of care plans.
• Promotion of service integration.
• Medication reconciliation.
• Interdisciplinary care team facilitation.
• Use of motivational interviewing and clinical guideposts.
• Assessment and addressing of barriers to care.
• Identification and development of prevention plans.
• Consultation and resource provision to peers.
• Complex case management.
• Telephonically completing assessments and managing care.

Benefits

Not specified.

Pay

$26.41 - $51.49 / HOURLY

Schedule

Monday – Friday, 8 AM – 5 PM working from home.