Care Manager, LTSS (RN)

Provides support for care management/care coordination long-term services and supports (LTSS)-specific activities. Collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. Facilitates comprehensive waiver enrollment and disenrollment processes. Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network. Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement. Promotes integration of services for members including behavioral health care and LTSS and home and community resources. Assesses for medical necessity and authorizes all appropriate waiver services. Evaluates covered benefits and advises regarding funding sources. Facilitates interdisciplinary care team meetings. Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. Assesses for barriers to care and provides care coordination and assistance. Identifies critical incidents and develops prevention plans. May provide consultation, resources and recommendations to peers. Care manager RNs may be assigned complex member cases and medication regimens and may conduct medication reconciliation. 25-40% estimated local travel in New Bedford to Fall River area.