Case Manager, LTSS (RN) Remote in New York

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. We are looking for a candidate with a RN licensure and Managed Care Organization (MCO) experience. Remote in New York- light travel to the office for meetings/training. Work hours: Monday through Friday 8:30AM- 5:00PM

Completes face-to-face comprehensive assessments of members per regulated timelines. Facilitates comprehensive waiver enrollment and disenrollment processes. Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals. Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members. Assesses for medical necessity and authorize all appropriate waiver services. Evaluates covered benefits and advise appropriately regarding funding source. Conducts face-to-face or home visits as required. Facilitates interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration. Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. Assesses for barriers to care, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns. Identifies critical incidents and develops prevention plans to assure member's health and welfare. Provides consultation, recommendations and education as appropriate to non-RN case managers Works cases with members who have complex medical conditions and medication regimens Conducts medication reconciliation when needed. 50-75% travel required.