Care Manager / Case Mgr (Rn) Remote (Wa Pref) Must Have Compact Licensure

Molina Healthcare; Rexburg (ID); Remote; USD 36,000 - 82,000; Full time

Benefits offered by this job

Competitive benefits

Remote work with PST hours

Job summary

Molina Healthcare is seeking an RN Care Manager for our Washington State Health Plan. This is a remote position with PST hours; WA preference but flexible. The role focuses on telephonic case management and transition-of-care for Medicare members, with no travel or night shifts.

You will assess member needs, develop care coordination plans with the care team, and collaborate to deliver integrated, quality, cost-effective care. Previous MCO care management experience is highly valued.

Qualifications

• Active RN license in state of practice
• At least 2 years healthcare experience, preferably in care management
• Proficient with EMR/EHR and HIPAA compliance
• Demonstrated knowledge of community resources
• Ability to work independently with minimal supervision

Responsibilities

• Perform comprehensive member assessments within timelines to determine care management needs
• Develop and implement care coordination plans with the member and care team
• Conduct telephonic, in-person, or home visits as required
• Monitor progress of the care plan and adjust as needed
• Maintain ongoing member caseload and outreach
• Promote integration of behavioral health, LTSS, and home/community resources
• Lead interdisciplinary care team meetings and collaborate with ICT
• Address barriers to care and provide coordination assistance
• May provide guidance to peers and manage complex cases

Skills

Care coordination

Telephonic case management

Multidisciplinary collaboration

HIPAA compliance

EMR proficiency

Education

Registered Nurse (RN) license

Tools

EMR/EHR systems

Job description

Molina Healthcare is hiring a remote RN Care Manager for our Washington State Health Plan. This role is remote, however there is a preference (not requirement) for candidates in Washington state. This role will be working Pacific Standard Time hours.

This role supports Medicare members through telephonic case management and transition-of-care functions, with no current travel, direct patient care, weekends, holidays, or night work.

Previous RN Care Management experience at an Managed Care Organization is highly desired.

Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. 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 assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments.
• Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals.
• Conducts telephonic, face-to-face or home visits as required.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member caseload for regular outreach and management.
• Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
• Facilitates interdisciplinary care team (ICT) meetings 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 concerns.
• May provide consultation, resources and recommendations to peers as needed.
• Care manager RNs may be assigned complex member cases and medication regimens.
• Care manager RNs may conduct medication reconciliation as needed.
• 25-40% estimated local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Valid and unrestricted driver\'s license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA).
• Demonstrated knowledge of community resources.
• Ability to operate proactively and demonstrate detail-oriented work.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and self-motivation.
• Responsiveness in all forms of communication, and ability to 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.

Preferred Qualifications

• Certified Case Manager (CCM).

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

Pay Range: $26.41 - $59.21 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.