Care Manager (RN) - Must live in IA

Molina Healthcare; Iowa (LA); On-site; USD 33,000 - 72,000; Full time

Job summary

Molina Healthcare is seeking a Care Manager RN to support care coordination and multidisciplinary collaboration. The role focuses on closing care gaps, member engagement and outcomes across the continuum.

You will work within various care settings, traveling as needed to ensure timely assessments and effective interventions. The position requires RN licensure, experience in care management or related healthcare settings, and the ability to navigate EMR systems and HIPAA requirements.

Qualifications

• 2+ years in health care, care management or related setting.
• RN license active in state of practice.

Responsibilities

• Complete comprehensive member assessments within timelines.
• Develop and implement care coordination plans with care team and support network.
• Conduct telephonic, in-person, or home visits as required.
• Monitor care plan effectiveness and document interventions.
• Maintain ongoing member caseload for outreach and management.
• Promote integration of services (behavioral health, LTSS, home and community resources).
• Facilitate ICT meetings and collaboration.
• Use motivational interviewing and Molina guidelines to support change.
• Identify barriers to care and assist members accordingly.
• May provide consultation and resources to peers.
• Travel 25-40% as required.

Skills

Care management

Communication

Time management

Critical thinking

Team collaboration

Travel readiness

Education

RN license

Tools

EMR system

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.

• Experience closing care gaps (HEDIS measures, medication adherence, HOS surveys).
• Comfort using care management platforms and population health tools.
• Track record of successful member engagement and outreach.
• Understanding of CMS Star Ratings methodology and quality bonus payments.

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)
• Experience with HEDIS measures, Medicare Regulations and STARS

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $23.76 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.