Care Manager (Michigan RN) (must reside in Michigan)

Molina Talent Acquisition; Saginaw (MI); On-site; USD 65,000 - 90,000; Full time

Job summary

Molina Healthcare is seeking a Registered Nurse for care management in Saginaw, MI. You will assess members, develop personalized care plans, and coordinate with physicians, caregivers, and the care network to improve outcomes and manage costs.

Responsibilities include traveling as needed, conducting visits, and monitoring progress while maintaining strong communication with the interdisciplinary team and ensuring compliance with HIPAA and EMR protocols.

Qualifications

• Active RN license in the state of practice.
• Experience in care management or medical/behavioral health settings preferred.
• Knowledge of EMR and HIPAA regulations.

Responsibilities

• Complete comprehensive member assessments within regulated timelines.
• Develop and implement care coordination plans with the care team.
• Conduct telephonic, home visits, or in-person contacts as required.
• Monitor and revise care plans based on progress and outcomes.
• Maintain caseload and coordinate services across LTSS and behavioral health.
• Facilitate ICT meetings and support team collaboration.

Skills

RN licensure

Care management knowledge

HIPAA compliance

EMR proficiency

Communication skills

Time management

Travel readiness

Interdisciplinary collaboration

Education

RN degree (BSN/ADN)

Tools

EMR systems

MS Office

Job description

JOB DESCRIPTION Job Summary

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.
• Assess 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.
• Up to 5% 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).
• Candidate should reside within a 20 mile radius of Saginaw, Michigan.
• Medicare Case Management experience preferred.
• Discharge planning experience preferred.