Care Manager (RN)

Molina Healthcare, Inc.; Washington; On-site; USD 36,000 - 82,000; Full time

Job summary

Molina Healthcare, Inc. seeks a licensed RN to provide support for care management and care coordination across the continuum.

You will work with a multidisciplinary team to develop and implement care plans aimed at achieving quality outcomes for members. The role requires engaging with members, caregivers, and providers, performing assessments within regulatory timelines, and promoting integration of services including behavioral health.

Qualifications

• Active RN license in the appropriate state.
• Experience in health care or care management.
• Ability to work independently with minimal supervision.
• Strong communication and organizational skills.
• Familiarity with EMR and HIPAA regulations.

Responsibilities

• Completes comprehensive member assessments within required timelines.
• Develops and implements care coordination plan with member, caregiver, physician and others.
• Conducts telephonic outreach as required.
• Monitors and documents care plan effectiveness and makes changes as needed.
• Maintains ongoing member caseload and regular outreach.
• Promotes integration of services across care settings (behavioral health, LTSS, home and community resources).
• Facilitates ICT meetings and collaboration.
• Uses motivational interviewing with members.
• Assesses barriers to care and provides assistance to members.
• May provide consultation to peers as needed.
• Care manager RNs may handle complex cases and medication reconciliation.

Skills

Care management experience

Time management

Communication skills

Microsoft Office

Detail-oriented

Education

RN license (active)

Tools

EMR systems

HIPAA knowledge

Online portals/databases

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 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.

Required Qualifications

• Previous 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

• Minimum 5 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.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

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 - $59.21 / HOURLY

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.