Care Manager (Rn) - Must Reside In Sc

Molina Healthcare; Simpsonville (SC); Remote; USD 35,000 - 71,000; Full time

Benefits offered by this job

Competitive benefits

Remote role

Travel opportunities

Job summary

Molina Healthcare is seeking an experienced RN to join our remote care management team serving South Carolina. You will support care coordination across the continuum, collaborate with a multidisciplinary team, and help drive quality and cost-effective member care.

This role requires SC RN license, minimum 2 years of health care experience, and willingness to travel locally 25-40%. You will conduct assessments, develop care plans, and participate in ICT meetings to improve member outcomes.

Qualifications

• Active SC RN license required.
• Minimum 2 years health care experience, care management preferred.
• Valid driver’s license and reliable transportation for travel.
• Proficient with EMR and HIPAA compliance.
• Strong communication and time-management skills.
• Ability to work independently in diverse settings.

Responsibilities

• Complete comprehensive member assessments within regulated timelines.
• Develop and implement care coordination plans with clinicians and family.
• Conduct telephonic, in-person, or home visits as needed.
• Monitor care plans, document interventions, and track outcomes.
• Maintain ongoing member caseload and proactive outreach.
• Promote integrated services across behavioral health, LTSS, and community resources.
• Facilitate interdisciplinary care team (ICT) meetings.
• Support peers with resources and recommendations as needed.
• May perform medication reconciliation when required.

Skills

Care management experience

EMR knowledge

HIPAA compliance

Communication skills

Time management

Education

RN license

Tools

EMR systems

Microsoft Office

Job description

Candidates must reside in South Carolina and hold an active South Carolina RN license.

This 100% remote role is part of our auto-dialer team that is fast paced and high volume. Not your typical care management role.

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, 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).

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

Pay Range: $25.08 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.