Care Manager (Rn) - Must Live In Illinois

Molina Healthcare; Chicago (IL); Remote; USD 39,000 - 74,000; Full time

Job summary

Molina Healthcare is seeking an Illinois-licensed RN Case Manager to support Medicare members in Illinois. This telephonic role may require occasional face-to-face meetings from home, with 8 AM–5 PM CST hours. Preference given to applicants with prior Medicare/MCO experience.

Travel could be 25–40% local based on contract requirements. Proficiency in Outlook, Excel, and Teams is expected. Responsibilities include completing assessments, coordinating care, and collaborating with multidisciplinary

Qualifications

• Active RN license in state of practice.
• 2+ years healthcare experience, preferably in care management or related settings.
• Valid driver’s license and ability to travel as required.
• Familiarity with EMR and HIPAA requirements.
• Strong communication and organizational skills.

Responsibilities

• Complete member assessments to determine care needs and services.
• Develop and implement care coordination plans with care teams.
• Conduct telephonic, in‑home or face-to-face visits as needed.
• Monitor and adjust care plans to achieve outcomes and cost-effectiveness.
• Maintain ongoing member caseload and coordinate with multidisciplinary teams.

Skills

RN experience

Telephonic case management

Microsoft Office proficiency

HIPAA knowledge

Time management

Communication skills

Adaptability

Education

Registered Nurse (RN) license

Tools

Microsoft Outlook

Excel

Teams

EMR systems

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.