Care Manager (RN) - Volusia County, FL

Molina Healthcare; United States; Presencial; USD 65.000 - 90.000; Jornada completa

Descripción de la vacante

Molina Healthcare, Inc. is hiring a Care Manager RN to support care management and coordination across the continuum. You will collaborate with a multidisciplinary team to ensure member progress toward outcomes and optimize quality and cost-effective care.

Your role involves comprehensive assessments, care plan development, and ongoing monitoring, with 25-40% local travel as required by state contracts. Strong communication and independent work style are essential for success.

Formación

• At least 2 years of health care experience, preferably in care management or related setting.
• Active RN license in state of practice.
• Valid driver's license and reliable transportation for travel.
• Knowledge of EMR and HIPAA regulations.

Responsabilidades

• Complete comprehensive member assessments within regulated timelines to identify care management eligibility.
• Develop and implement care coordination plans with member, caregivers, and health professionals.
• Conduct telephonic, in-person, or home visits as required.
• Monitor care plan effectiveness and adjust interventions as needed.
• Maintain ongoing member caseload and outreach.
• Promote integration of services across behavioral health, LTSS, and community resources.
• Facilitate ICT meetings and collaborative teamwork.
• Provide education and motivational interviewing to support behavior change.
• Identify barriers to care and provide assistance.
• May provide consultation to peers; complex cases may involve medication reconciliation.

Conocimientos

Verbal and written communication

Time management

Critical thinking

Problem solving

Independent work

Attention to detail

Collaboration with diverse populations

Cultural competency

EMR systems navigation

HIPAA compliance knowledge

Microsoft Office

Educación

Registered Nurse (RN). License active and unrestricted in state of practice

Herramientas

EMR systems navigation

HIPAA compliance knowledge

Microsoft Office

Descripción del empleo

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.

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