Care Manager (RN)

Molina Healthcare; Miami (FL); On-site; USD 70,000 - 98,000; Full time

Job summary

Molina Healthcare is seeking an RN care manager in Miami, FL to support care coordination across the continuum. You will collaborate with multidisciplinary teams to ensure quality, cost-effective member care and positive outcomes.

Responsibilities include assessing members, developing care plans, and monitoring progress while maintaining strong communication with caregivers and healthcare professionals. Travel may be required to support state contracts.

Qualifications

• Active RN license in state of practice.
• Minimum 2 years healthcare experience, preferably care management.
• Valid driver's license and reliable transportation.
• Understanding of EMR and HIPAA requirements.
• Ability to work independently and manage multiple projects.
• Strong communication and time management skills.
• Experience working with diverse populations.
• Knowledge of community resources.

Responsibilities

• Assess members and determine care management eligibility.
• Develop and implement care coordination plans.
• Conduct telephonic, in-person, or home visits as required.
• Monitor care plans and document interventions.
• Maintain ongoing member caseload and outreach.
• Promote integration of services across care teams.
• Facilitate interdisciplinary care meetings.
• Educate and motivate change using motivational interviewing.
• Identify and address barriers to care.

Skills

RN

Care coordination

Communication

Independent work

Time management

Education

RN license

Tools

EMR software

Microsoft Office

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