Case Manager, Transplant (RN) : California

Molina Healthcare; Long Beach (CA); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a dedicated Transplant Case Manager to join their team. This fully remote position offers the opportunity to work with a multidisciplinary team to assess, facilitate, and coordinate care for members pursuing transplants. You will play a crucial role in ensuring patients receive quality care while navigating their journey through the healthcare system. With a focus on collaboration and patient education, you will help members achieve their health goals and improve their outcomes. If you are passionate about making a difference and have a strong background in case management, this role is perfect for you.

Qualifications

• 3+ years of hospital acute care/medical experience required.
• Active, unrestricted State Registered Nursing (RN) license in California.

Responsibilities

• Coordinate care for transplant members and ensure optimal outcomes.
• Educate members on medication management and follow-up care.
• Monitor care plans and adjust as needed for effectiveness.

Skills

Case Management

Patient Education

Interdisciplinary Collaboration

Motivational Interviewing

Clinical Assessments

Education

Bachelor's Degree in Nursing

Graduate from an accredited School of Nursing

Tools

Personal Health Records

Job description

Job Description

California residents preferred. Candidates who do not live in California must work California Pacific business hours. This position is 100% remote at this time.

Job Summary

Transplant Case Managers work with members, providers, Transplant Programs, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including transitions of care and outpatient care management for members pursuing a transplant. They ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Knowledge/Skills/Abilities

• Conduct inpatient reviews for members on the transplant journey to determine financial responsibility of Molina Healthcare and its members.
• Process requests within required timelines.
• Assess inpatient services for members to ensure optimal outcomes, cost-effectiveness, and compliance with all state and federal regulations and guidelines.
• Identify appropriate benefits, eligibility, and expected length of stay for requested treatments and/or procedures.
• Refer appropriate cases to Medical Directors and present them efficiently.
• Collaborate with multidisciplinary teams to promote the Molina Care Model.
• Follow transplant members through a 30-day Transitions of Care intervention from hospital admission through transitions to other settings, including nursing facilities and private homes, aiming to reduce readmissions.
• Ensure safe and appropriate transitions by collaborating with hospital discharge planners, hospitalists, outpatient providers, facility staff, and family/support networks as needed.
• Ensure member transitions to settings with adequate caregiving, functional support, and medical oversight.
• Coordinate care with ancillary providers, public agencies, and other service providers to ensure necessary services and equipment are in place for safe transition.
• Reassess member needs post-discharge and coordinate care accordingly.
• Educate and support members in medication management, use of personal health records, follow-up care, recognizing worsening conditions, nutrition, functional needs, home and community-based services, and advance directives.
• Complete clinical assessments per regulated timelines and determine eligibility for case management based on clinical judgment, health changes, psychosocial wellness, and assessment triggers.
• Develop and implement case management plans collaboratively with the member, caregivers, healthcare professionals, and support network to address needs and goals.
• Monitor care plans continuously, evaluate effectiveness, document interventions, and adjust as needed.
• Promote integration of services including behavioral health, social determinants of health, and long-term supports to enhance continuity of care.
• Facilitate interdisciplinary care team meetings and informal collaboration.
• Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members.
• Identify barriers to care and assist members in addressing concerns.
• Maintain a caseload for regular outreach and management.
• Adhere to healthcare policies and procedures.

Job Qualifications

Required Education: Graduate from an accredited School of Nursing.

Required Experience: 3+ years hospital acute care/medical experience; 1-3 years in case management, disease management, managed care, or medical/behavioral health settings.

Required License, Certification, Association: Active, unrestricted State Registered Nursing (RN) license in good standing; must be licensed in California; valid driver’s license with a good driving record and reliable transportation.

Preferred Education: Bachelor's Degree in Nursing.

Preferred Experience: Recent hospital experience in ICU, Medical, or ER units; 1-3 years hospital discharge planning or home health; 3-5 years in transplant case management, disease management, managed care, or health settings.

Preferred License, Certification, Association: Active, unrestricted Utilization Management Certification (CPHM); 3-5 years hospital discharge planning or home health.

Physical Demands

The working environment is generally favorable with adequate lighting and temperature. Work is mainly performed in an office setting with minimal exposure to hazards. Must be able to sit for long periods. Reasonable accommodations can be made for individuals with disabilities.

To all current Molina employees: Interested candidates should apply through the intranet job listing.

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