Care Manager (RN)

Molina Talent Acquisition; Ohio; On-site; USD 65,000 - 90,000; Full time

Job summary

Molina Healthcare, Inc. seeks a registered nurse to support care management and coordinate care across the continuum. You will collaborate with the member, family, physician, and care team to address needs and goals, and conduct assessments within regulatory timelines.

The role involves visits or telephonic contacts, monitoring plans, and promoting integration of services, including behavioral health and LTSS. Proficiency with EMR/HIPAA and Microsoft Office is essential.

Qualifications

• At least 2 years of health care experience in care management or related settings.
• RN license active and unrestricted in state of practice.
• Valid driver’s license, reliable transportation, and adequate auto insurance for job-related travel requirements.
• Understanding of EMR and HIPAA.
• Demonstrated knowledge of community resources.
• Ability to operate proactively and detail-oriented work.
• Ability to work in diverse settings with various populations.
• Ability to work independently with minimal supervision.
• Strong communication skills, both verbal and written.
• Proficiency with Microsoft Office and online portals/databases.

Responsibilities

• Completes comprehensive member assessments within regulated timelines to identify care management eligibility.
• Develops and implements care coordination plans with members, families, physicians and other health professionals.
• Performs telephonic, in-person, or home visits as required.
• Monitors and documents progress of the care plan; evaluates effectiveness and adjusts as needed.
• Maintains ongoing member caseload with regular outreach and follow-up.
• Promotes integration of services, including behavioral health and LTSS, to enhance continuity of care.
• Facilitates ICT meetings and collaboration among care teams.
• Uses motivational interviewing and Molina clinical guidelines to support change.
• Identifies barriers to care and provides coordination and assistance to address concerns.
• May provide consultation and recommendations to peers.
• RN care managers may handle complex cases and med reconciliation.
• Travel 25-40% may be required.

Skills

Care coordination

Communication skills

Time management

Problem-solving

Independent work

Education

Registered Nurse (RN) license

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).

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Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V