Registered Nurse

JOB DESCRIPTION

Opportunity for an experienced Care Manager (Bachelors or Masters trained) in Northern Cook County to join our LTSS Team working with our Medicaid members in communities north of Berwyn and Cicero. We would also be interested in candidates in SE McHenry County or the southern part of Lake County. Part of the responsibilities of the role is to conduct face-to-face meetings with the members in their homes.

Preference will be given to those candidates with previous care management experience in an MCO. Mileage is reimbursed as part of our benefits package. Hours are Monday – Friday, 8 AM – 5 PM CST.

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.

Job Summary

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. 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 of 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.

• 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,…