Care Manager (Rn) - Must Live In Illinois

Molina Healthcare; Rockford (IL); Hybrid; USD 44,000 - 74,000; Full time

Job summary

Molina Healthcare in Illinois is seeking an experienced Registered Nurse to join as a Case Manager for Medicare members. This telephonic role may require face-to-face visits at times and involves coordinating care across multiple providers to determine needed services.

Ideal candidates will have at least 2 years in health care, EMR/HIPAA proficiency, and strong communication. Travel up to 40% may be necessary depending on member needs and location.

Qualifications

• 2+ years in health care, care management preferred.
• Active RN license.
• Valid driver’s license and reliable transportation.
• HIPAA knowledge.
• Ability to work telephonically with occasional in-person visits.
• Strong communication and time-management skills.

Responsibilities

• Complete comprehensive assessments per timelines to determine care needs.
• Develop and implement care coordination plans with member, caregivers, and providers.
• Conduct telephonic, face-to-face or home visits as required.
• Monitor and adjust care plans; document interventions and outcomes.
• Maintain ongoing member caseload with regular outreach.
• Promote integration of services across care teams.
• Assist with medication reconciliation as needed.

Skills

RN license

EMR knowledge

HIPAA knowledge

MS Office

Communication

Time management

Detail oriented

Tools

EMR system

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.