CASE MANAGER RN - WAIVER LTSS
Company: Molina Healthcare
Location: Winchester
Posted on: October 10, 2024
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Job Description:
JOB DESCRIPTIONThis position will support our MMP (Medicaid
Medicare Population) with members on Waiver program. This position
will have a case load and manage members enrolled in this program.
We are looking for Registered Nurses who have experience working
with manage care population and/or case management role. Excellent
computer skills and diligence are especially important to multitask
between systems, talk with members on the phone, and enter accurate
contact notes. This is a fast-paced position and productivity is
important. This position requires field work doing assessments with
members face to face in homes.TRAVEL in the field to do member
visits in the surrounding areas will be required: Franklin
CountyTravel will be up to 20% of the time (5 to 10 Visits a month)
(Mileage is reimbursed)Schedule - Monday thru Friday 800 AM to 5 PM
EST (No weekends or Holidays)Job SummaryMolina 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/ABILITIESCompletes 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
managersWorks cases with members who have complex medical
conditions and medication regimensConducts medication
reconciliation when needed.50-75% travel required.JOB
QUALIFICATIONSRequired EducationGraduate from an Accredited School
of NursingRequired ExperienceAt 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, AssociationActive,
unrestricted State Registered Nursing license (RN) in good
standingIf 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
RequirementsVirginia: Must have at least one year of experience
working directly with individuals with Substance Use
DisordersPreferred EducationBachelor's Degree in NursingPreferred
Experience3-5 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, AssociationActive 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.Pay Range: $23.76 - $51.49 /
HOURLY*Actual compensation may vary from posting based on
geographic location, work experience, education and/or skill
level.
Keywords: Molina Healthcare, Bethesda , CASE MANAGER RN - WAIVER LTSS, Executive , Winchester, Maryland
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