Telephonic Case Manager, LTSS (RN) Behavioral Health - TEXAS ONLY

$49,421 - $107,099/Yr

Molina Healthcare - Sunland Park, NM

Full-time - Mid Level

Sunland Park, NM

Insurance Carriers and Related Activities

About the position

The Telephonic Case Manager for Behavioral Health at Molina Healthcare is responsible for providing comprehensive assessments and case management for Medicaid members with behavioral health and substance abuse disorders. This role involves coordinating care across various services, ensuring quality and cost-effective treatment, and promoting integration of services to enhance continuity of care. The position requires strong communication skills and the ability to work collaboratively with healthcare professionals and members' support networks.

Responsibilities

• Complete comprehensive assessments of members with behavioral health/substance abuse disorder diagnoses.
• Facilitate waiver enrollment and disenrollment processes.
• Develop and implement case management plans in collaboration with members and healthcare professionals.
• Monitor care plans for effectiveness and suggest changes as needed.
• Promote integration of behavioral health care and long-term services for continuity of care.
• Assess 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 approvals or denials.
• Use motivational interviewing to educate and support members during contacts.
• Identify barriers to care and provide coordination to address them.
• Develop prevention plans for critical incidents to ensure 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 necessary.

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.
• Valid driver's license with a good driving record if field work is required.

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 populations receiving waiver services.
• Active and unrestricted Certified Case Manager (CCM).

Benefits

• Competitive compensation package
• Health insurance
• Dental insurance
• Vision insurance
• 401k plan
• Paid time off
• Flexible scheduling options