Care Manager (RN)

Molina Healthcare; Ohio; In loco; USD 65.000 - 90.000; Tempo pieno

Descrizione del lavoro

Molina Healthcare is seeking a skilled Registered Nurse for care management and care coordination roles. The position involves collaborating with a multidisciplinary team to deliver integrated member care across settings, ensuring progress toward outcomes and aligning with Molina's strategy for quality and cost-effective care.

Responsibilities include assessments, care plan development, member outreach, and coordination with healthcare professionals.

Competenze

• Active RN license in the state of practice
• Minimum 2 years experience in health care, care management or related field
• Knowledge of EMR and HIPAA
• Strong communication and problem-solving skills
• Willingness to travel 25-40% as required

Mansioni

• Assess members per timelines and determine eligibility for care management
• Develop and implement coordinated care plans with members and providers
• Conduct telephonic, in-person or home visits as needed
• Monitor care plan effectiveness and document outcomes
• Maintain ongoing member caseload and outreach
• Promote integration of behavioral health, LTSS and community resources
• Facilitate interdisciplinary care team meetings
• Use motivational interviewing to support member change
• Identify barriers to care and provide solutions
• May provide consultation to peers as needed
• Care manager RNs may handle complex cases and medication reconciliation
• Travel percentage 25-40% may be required

Conoscenze

RN License Active

Detail-oriented

Time management

Communication skills

Travel readiness

Formazione

RN License / Registered Nurse

Strumenti

EMR systems

HIPAA knowledge

Descrizione del lavoro

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