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Be aware that third parties posing as Molina Healthcare may be soliciting money from job seekers and extending offers to candidates who have not interviewed. Molina does not engage in these type of practices. If you have received an offer and have not been engaging with Molina Healthcare in an interview process, reach out to erc@molinahealthcare.com to validate the legitimacy of your offer. Please note that Molina has reported this activity to the appropriate law enforcement agencies for further investigation. If you feel you’ve been victimized, please report it to local law enforcement.

Registered Nurse Case Manager MLTC, LTSS Remote in NY NJ or CT

Molina Healthcare New York, New York Job ID 2026971
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As a Case Manager, you will work 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.

  • Full Time
  • Level: Mid-Level
  • Travel: Yes

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Success Profile

What makes you a successful Case Manager at Molina Healthcare? Check out the traits we're looking for and see if you're the right fit.

  • Consultative
  • Patient
  • Analytical
  • Quick-Thinking
  • Compassionate
  • Problem-Solver

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I love working at a company that sees our members as people not numbers and allow employees to provide individual care to meet the member’s needs.

-Lori K. MS, BSW, CADC, Case Manager

If they feel someone cares about them, they are more likely to care for themselves, and their health, in return. Sometimes we have to be their only friend.

-Joanne J., Case Manager

A member’s care is enhanced when their care providers think deeply about their situation and then offer assistance and guidance.

-Brent A., Case Manager

Benefits

  • Insurance

    Medical · Dental · Vision
    Group & Voluntary Life Insurance
    Aflac · Pet Health · Identity Theft
    Auto & Home Insurance

  • Savings

    Flexible Spending Accounts
    401K · Roth 401K
    Employee Stock Purchase Plan

  • Career Growth

    Continuing Education Units
    Education Reimbursement

  • Time Off

    Paid Time Off
    Volunteer Time Off
    Company Holidays

  • Additional Perks

    Legal Assistance Plan
    Employee Assistance & Well Being Programs
    Employee Perks Platform
    Rideshare Portal

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Responsibilities

JOB DESCRIPTION

Job Summary

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.

This position will support our Senior Whole Health business. Senior Whole Health by Molina is a Managed Long-Term Care (MLTC), and Medicaid Advantage (MAP) plan. These plans streamline the delivery of long-term services to chronically ill or disabled people who are eligible for Medicaid and Medicare.We are looking for Case Managers with a New York RN licensure. Experience with Long-term Services and Supports (LTSS) is highly preferred. Strong organizational and time management skills.  The Case Manager must have the ability to work in a high-volume environment to better serve our members. Bilingual candidates are encouraged to apply.

Remote position within the Tri-state area. (New York, New Jersey, or Connecticut)

Work hours: Monday - Friday 8:00am - 5:00pm

KNOWLEDGE/SKILLS/ABILITIES

  • 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.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing

Required Experience

  • 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.
  • Required License, Certification, Association
  • Active, unrestricted State Registered Nursing license (RN) in good standing
  • If field work is required, Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements

Virginia: Must have at least one year of experience working directly with individuals with Substance Use Disorders

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

  • 3-5 years in case management, disease management, managed care or medical or behavioral health settings.
  • 1 year experience working with population who receive waiver services.
  • Managed Long-Term Care (MLTC) experience.
  • Home health experience
  • Experience working with the geriatric population.
  • Ability to manage a high case load, up to 200 cases.
  • Must be able to work in a fast pace/high volume environment.
  • Bilingual

Preferred License, Certification, Association

Active and unrestricted Certified Case Manager (CCM)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $23.76 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

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.

Job Type: Full Time Posting Date: 09/03/2024

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