Care Manager (RN)

Molina Healthcare; Bothell (WA); Híbrido; USD 80.000 - 100.000; Jornada completa

Descripción de la vacante

Molina Healthcare, Inc. is seeking an experienced Care Manager RN to support pediatric members in a hybrid role across King County. The position involves coordinating care, assessing needs, and partnering with families, physicians and the care team to improve outcomes.

The role requires remote care management experience, strong communication, and the ability to travel locally (10%) to member homes and clinics. A valid RN license and driving acceptable in-state requirements are essential.

Formación

• At least 2 years experience in health care, preferably in care management, or equivalent.
• Active RN license in state of practice and valid driving license.
• Understanding of EMR/HIPAA and community resources.
• Ability to work independently and manage multiple tasks with strong communication.
• Willingness to travel locally (10%) to member homes/clinics.

Responsabilidades

• Complete comprehensive member assessments per timelines and determine care-management eligibility.
• Develop and implement care coordination plans with members, families, and care team.
• Conduct telephonic, in-person, or home visits as required.
• Monitor care plans and document interventions and outcomes; adjust as needed.
• Maintain a caseload and coordinate integration of services across providers.

Conocimientos

Care management

RN license

HIPAA knowledge

Communication skills

Time management

Independent work

Travel readiness

Educación

Registered Nurse (RN) license

Descripción del empleo

JOB DESCRIPTION

Hybrid role with approximately 10% local travel within King County Candidates should have care management experience in Pediatrics, NICU, or Private Duty Nursing, with responsibility for managing a caseload of 30-35 members. Prior experience working remotely in a care management or clinical setting is required, along with the ability to independently coordinate care, manage complex cases, and support positive outcomes for pediatric populations.

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.
• 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