Care Manager (Rn)

Molina Healthcare; Cincinnati (OH); On-site; USD 36,000 - 71,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare, Inc. is seeking a Care Manager RN to support care management activities and coordinate integrated member care across the continuum.

You will collaborate with a multidisciplinary team to drive outcomes, conduct assessments and implement care plans, including possible home visits and travel to member locations. The role emphasizes proactive care management, communication across care teams, and the use of EMR/HIPAA guidelines to ensure high-quality, cost-effective care for

Qualifications

• At least 2 years experience in health care, preferably in care management, or equivalent
• Registered Nurse (RN) license active and unrestricted in state of practice
• Valid driver's license and reliable transportation for travel requirements
• Understanding of EMR and HIPAA regulations
• Knowledge of community resources and ability to work independently and proactively
• Strong communication and time-management skills

Responsibilities

• Complete comprehensive member assessments within regulated timelines
• Develop and implement care coordination plans with members and care teams
• Conduct telephonic, face-to-face, or home visits as needed
• Monitor care plans, document interventions, and adjust as necessary
• Maintain ongoing member caseload with regular outreach
• Promote integration of behavioral health, LTSS, and community resources
• Facilitate interdisciplinary care team meetings and collaboration
• Provide education and motivation using motivational interviewing
• Identify barriers to care and address member concerns
• May provide consultation to peers and manage complex cases
• Travel up to 25–40% depending on state requirements

Skills

RN licensure

Care management

Healthcare experience

EMR systems

HIPAA knowledge

Tools

EMR systems

HIPAA compliance

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.
• 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 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.