CASE MANAGER RN - WAIVER LTSS

$49,421 - $107,099/Yr

Molina Healthcare - Winchester, VA

Full-time

Winchester, VA

Insurance Carriers and Related Activities

About the position

This position supports the Medicaid Medicare Population (MMP) by managing a caseload of members enrolled in the Waiver program. The role involves conducting face-to-face assessments in members' homes, coordinating care, and ensuring quality service delivery. The ideal candidate is a Registered Nurse with experience in managed care and case management, capable of multitasking in a fast-paced environment.

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 as needed.
• 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 member 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.

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