Care Manager (Rn) - Must Live In Illinois

Molina Healthcare; Aurora (IL); Remote; USD 38,000 - 74,000; Full time

Job summary

Molina Healthcare is seeking an Illinois-licensed RN to join as a Case Manager coordinating care for Medicare members. The role is telephonic with some in-person visits, mainly from home, Monday–Friday 8 AM–5 PM CST. Travel may be required up to 25–40% depending on state rules.

Applicants with prior Medicare or managed care experience are preferred. Strong proficiency in Microsoft Office and EMR/HIPAA familiarity are essential for documentation and coordination tasks.

Qualifications

• Active RN license in Illinois
• 2+ years healthcare experience, care management preferred
• EMR/HIPAA knowledge
• Valid driver’s license and reliable transportation
• Ability to work independently and manage multiple tasks
• Strong communication and documentation skills
• Proficiency with Microsoft Office suite and online portals

Responsibilities

• Complete comprehensive member assessments to determine care management eligibility
• Develop and implement care coordination plans with member and care team
• Conduct telephonic, face-to-face, or home visits as required
• Monitor and document care plan effectiveness and adjust as needed
• Maintain ongoing member caseload for outreach and management
• Promote integration of behavioral health, LTSS, and community resources
• Facilitate ICT meetings and cross-functional collaboration
• Educate and motivate members using motivational interviewing and Molina guides
• Identify barriers to care and provide resources and referrals
• Possible medication reconciliation and complex case support

Skills

Strong communication

Time management

Detail oriented

Independent worker

Education

RN license (active)

Tools

Microsoft Office

Outlook

Excel

Teams

Job description

JOB DESCRIPTION

Opportunity for Illinois licensed RN to join Molina as a Case Manager working with our Medicare members who reside in Illinois. You will complete assessments needed for determining the types of services we will provide to them. While this role is telephonic, there may be times that you will have to meet with the member face-to-face. Preference will be given to those candidates with previous experience working with the Medicare population within a managed care organization (MCO) like Molina. Hours are Monday – Friday, 8 AM – 5 PM CST working from home.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, and Teams as well as being confident in moving between different programs to complete the necessary forms and documentation.

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.

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).

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).

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

Pay Range

$27.73 - $54.06 / HOURLY

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