Field Case Manager, LTSS (RN)

$54,933 - $107,099/Yr

Molina Healthcare - Conroe, TX

Full-time - Mid Level

Conroe, TX

Insurance Carriers and Related Activities

About the position

Molina Healthcare is seeking a Texas licensed Registered Nurse (RN) to join their team as a Case Manager. This role involves working with Medicaid members in the Conroe, Bay City, and Spring areas, conducting face-to-face assessments in members' homes to determine necessary services. The position emphasizes collaboration with multidisciplinary teams to ensure quality care and effective service delivery for members with high needs, particularly those in long-term services and supports (LTSS).

Responsibilities

• Conduct 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 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 health and welfare.
• Provide consultation and recommendations 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 populations receiving waiver services.
• Active and unrestricted Certified Case Manager (CCM).

Benefits

• Mileage reimbursement as part of the benefits package.
• Competitive benefits and compensation package.