Case Manager RN, LTSS Waiver

$49,421 - $107,099/Yr

Molina Healthcare - Cincinnati, OH

Full-time - Mid Level

Cincinnati, OH

1,001-5,000 employees

Insurance Carriers and Related Activities

About the position

The Case Manager RN for the LTSS Waiver program at Molina Healthcare is responsible for assessing, planning, and coordinating care for members with high needs, particularly those in the Medicare Waiver Population. This role involves both telephonic and face-to-face assessments, requiring excellent computer skills and attention to detail to manage multiple systems and document interactions accurately. The position is fast-paced and requires travel to meet with members in the Cincinnati, OH area.

Responsibilities

• Complete face-to-face comprehensive assessments of members per regulated timelines.
• Facilitate comprehensive waiver enrollment and disenrollment processes.
• Develop and implement a case management plan in collaboration with the member, caregiver, physician, and other healthcare professionals.
• Perform ongoing monitoring of the care plan to evaluate effectiveness and suggest changes accordingly.
• Promote integration of services for members including behavioral health care and long-term services and supports.
• Assess for medical necessity and authorize all appropriate waiver services.
• Conduct face-to-face or home visits as required.
• Facilitate interdisciplinary care team meetings for approval or denial of services.
• Use motivational interviewing to educate and support members during contacts.
• Assess for barriers to care and provide care coordination to address obstacles.
• Identify critical incidents and develop prevention plans to assure member's health and welfare.
• Provide consultation and recommendations to non-RN case managers.
• Conduct medication reconciliation when needed.

Requirements

• Graduate from an Accredited School of Nursing.
• Active, unrestricted State Registered Nursing license (RN) in good standing.
• 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.

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 population who receive waiver services.
• Active and unrestricted Certified Case Manager (CCM) certification.

Benefits

• Health insurance
• Internet reimbursement