Case Manager, LTSS (RN) - Field travel in Jefferson County, WI

$54,933 - $107,099/Yr

Molina Healthcare - Watertown, WI

Full-time - Entry Level

Watertown, WI

Insurance Carriers and Related Activities

About the position

The position involves working with Molina Healthcare Services to assess, facilitate, plan, and coordinate integrated care delivery for members with high need potential. The role focuses on ensuring quality care that is medically appropriate and cost-effective, particularly for individuals with disabilities or chronic conditions. The case manager will engage in comprehensive assessments, develop care plans, and promote service integration to enhance continuity of care.

Responsibilities

• Completes face-to-face comprehensive assessments of members per regulated timelines.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• Develops and implements a case management plan in collaboration with the member, caregiver, physician, and other healthcare professionals.
• Performs ongoing monitoring of the care plan to evaluate effectiveness and suggest changes accordingly.
• Promotes integration of services for members including behavioral health care and long-term services and supports.
• Assesses for medical necessity and authorizes all appropriate waiver services.
• Evaluates covered benefits and advises appropriately regarding funding sources.
• Conducts face-to-face or home visits as required.
• Facilitates interdisciplinary care team meetings for approval or denial of services.
• Uses motivational interviewing to educate and support members during contacts.
• Assesses for barriers to care and provides care coordination to address obstacles.
• Identifies critical incidents and develops prevention plans to assure member's health and welfare.
• Provides consultation and education to non-RN case managers.
• Works with members who have complex medical conditions and medication regimens.
• Conducts medication reconciliation when needed.

Requirements

• Graduate from an Accredited School of Nursing.
• At 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.
• Active, unrestricted State Registered Nursing license (RN) in good standing.
• If field work is required, must have a valid driver's license with a good driving record.

Nice-to-haves

• Bachelor's Degree in Nursing.
• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.
• 1 year experience working with a population who receive waiver services.
• Active and unrestricted Certified Case Manager (CCM)

Benefits

• Competitive benefits and compensation package.