Case Manager RN - Medicaid LTSS (RN) Suffolk, VA

$57,678 - $112,445/Yr

Molina Healthcare - Suffolk, VA

Full-time - Mid Level

Suffolk, VA

Insurance Carriers and Related Activities

About the position

The Registered Nurse (RN) Case Manager will work primarily in a remote and field setting, supporting the Medicaid population in Virginia. This role involves conducting face-to-face assessments in members' homes, participating in interdisciplinary care team meetings, and developing care plans tailored to members' health needs. The position requires excellent computer skills and attention to detail, as well as the ability to multitask effectively in a fast-paced environment. The RN will be responsible for ensuring that members receive appropriate care and support, with a focus on quality and cost-effective outcomes.

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 appropriate waiver services.
• Evaluate covered benefits and advise on funding sources.
• Conduct face-to-face or home visits as required.
• Facilitate interdisciplinary care team meetings for service approval or denial.
• Use motivational interviewing to educate and support members during contacts.
• Assess for barriers to care and provide coordination to address obstacles.
• Identify critical incidents and develop prevention plans for members' health and welfare.
• Provide consultation and education to non-RN case managers.
• Work with members who have complex medical conditions and medication regimens.
• Conduct 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/behavioral health settings.
• Active, unrestricted State Registered Nursing license (RN) in good standing.
• Valid driver's license with a good driving record and reliable transportation.

Nice-to-haves

• Bachelor's Degree in Nursing.
• 3-5 years in case management, disease management, managed care, or medical/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.