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At least 2 years health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential.

HOUR

This is a remote field-based role requiring travel. This is an opportunity for either an experienced Care Manager who is Bachelors or Masters trained in a social services field OR an Iowa licensed RN to join the LTSS team with our Iowa Health Plan. Responsibilities include conducting face-to-face and telephonic visits with our Medicaid members, completing assessments to determine the types of services we need to provide, and managing their care until they are discharged from your service.  The ideal candidate will have experience as a Care Manager within a managed care organization (MCO) like Molina or have experience working with IHH assessments. Hours are Monday – Friday, 8 AM – 5 PM CST; 75% of your time will be spent in the field and the remainder you will work from your home office. Mileage is reimbursed as part of our benefit package.Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, and Teams as well as being confident in moving between different programs to complete the necessary forms and documentation. Due to contractual requirements with Iowa, we are unable to hire LPN/LVNs for this role. Job SummaryProvides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. 
  Essential Job Duties 
 • 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 to address the member needs and goals. 
 • Performs ongoing monitoring of 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 (LTSS) and home and community resources to enhance continuity of care. 
 • Assesses for medical necessity and authorizes all appropriate waiver services. 
 • Evaluates covered benefits and advises appropriately regarding funding sources. 
 • Facilitates interdisciplinary care team (ICT) 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 and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. 
 • Identifies critical incidents and develops prevention plans to assure member health and welfare. 
 • Collaborates with licensed care managers/leadership as needed or required. 
 • 25-40% estimated local travel may be required (based upon state/contractual requirements). 
  Required Qualifications• At least 2 years health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. •Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.• In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.• Demonstrated knowledge of community resources.• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.• Ability to operate proactively and demonstrate detail-oriented work.• Ability to work independently, with minimal supervision and self-motivation.• Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations.• Ability to develop and maintain professional relationships.• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.• Excellent problem-solving, and critical-thinking skills.• Strong verbal and written communication skills.• Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.• In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). Preferred Qualifications• Certified Case Manager (CCM), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice. 
 • Experience working with populations that receive waiver services. 
  To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
 Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $22.8 - $46.81 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Molina Healthcare

Care Manager, LTSS - Must reside in IA

Auto Insurance

Behavioral Health

Business Model

Certified Case Manager (CCM)

Clinical Competency

Communication Skills

Community and Social Services

Compensation and Benefits

Contract Requirements

Cross-Functional

Denial of Service (DoS)

Detail Oriented

Documentation

Driver's License

Establish Priorities

Funding

Health Plan

Healthcare

Internet Portal

Leadership

Legal

Licensed Practical Nurse/Licensed Vocational Nurse

Licensing

Long-Term Care

Managed Care

Medicaid

Microsoft Excel

Microsoft Office

Microsoft Outlook

Multitasking

Network Support

Presentation/Verbal Skills

Problem Solving Skills

Registered Nurse (RN)

Social Work

State Laws and Regulations

Team Lead/Manager

Time Management

Willing to Travel

Writing Skills

TMP PX

Hines and Associates only hires licensed/certified medical professionals with an unrestricted license/certification in the state or in a state that has licensure reciprocation with the state of the office location the employee is working in. Our Case Manager role allows you to utilize your clinical nursing experience to develop a plan for meeting health care needs of the patient, while continuing to professionally grow in health care knowledge and perspective.

Description:About UsHines is a nationwide, independent leader in personalized managed health care, focused on what’s important to you—comprehensive services with the program excellence and cost containment that you demand. Hines & Associates, Inc.’s reputation as an industry leader is founded on over three decades of innovative and professional health care excellence. Serving all aspects of the industry, Hines is committed to conserving health care dollars while ensuring quality care through effective programs and personalized service. We are growing and are looking for nurses who are ready to leave hands on nursing and expand their careers! Come work in a supportive, safe and friendly environment that provides opportunities for growth! Overview:Our Case Manager role allows you to utilize your clinical nursing experience to develop a plan for meeting health care needs of the patient, while continuing to professionally grow in health care knowledge and perspective. Be the patient advocate you desire to be!  Specialty Case Manager positions also available!<ul><li>Oncology:                    Minimum of 2 years acute oncology preferred but not required.</li><li>Chronic Condition:   Minimum of 2 years of disease management preferred but not required.</li><li>Behavioral Health:   Minimum of 2 years in a full-time acute inpatient setting or specialty area (i.e., emergency department,      inpatient BH (including float), or treatment program)</li></ul> This position is full-time, Monday - Friday, no weekends or nights! This is an in-office position until successful completion of the orientation period and then there is an option for a hybrid option of two days working from home and three days in the office.<ul><li>A regular full-time schedule.</li><li>Hybrid home/office opportunity after successful completion of orientation period.</li><li>No weekends, nights or holidays!</li><li>Competitive Benefit Package</li><li>401K with company match</li><li>Generous time off policy</li></ul>Hines is a 37 year company recognized in the industry for high standards and quality work PM21Requirements:Qualifications:<ul><li>Hines and Associates only hires licensed/certified medical professionals with an unrestricted license/certification in the state or in a state that has licensure reciprocation with the state of the office location the employee is working in. Must be an RN.</li><li>Successful completion of case management orientation program</li><li>Minimum of 2 years full timeacute impatient setting or specialty area (i.e. ICU, ER, Oncology, NICU, Acute Rehab)</li><li>Excellent communication skills</li><li>Basic typing/computer knowledge with minimum keyboarding speed of 35WPM; 6) Previous case management experience helpful but not required.</li><li>Previous case management or insurance industry experience helpful but not required.</li></ul>Physical Requirements:<ul><li>No significant physical exertion required.</li><li>rare travel to do onsite evaluations for patients as required at homes, hospitals, etc.</li></ul>*Hines welcomes diversity and as an equal opportunity employer all qualified applicants will be considered regardless of race, religion, color, national origin, sex, age, sexual orientation, gender identity, disability or protected veteran status.* PIb3d87d033387-25401-36839691

Hines & Associates Inc

Case Manager - RN

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Care Manager, LTSS - Must reside in IAMolina Healthcare

Case Manager - RNHines & Associates Inc

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