Pediatric Care Manager (RN)-Hybrid in Miami-Dade County, FL

Molina Healthcare, Inc.; Miami (FL); Vor Ort; USD 36.000 - 71.000; Vollzeit

Benefits dieser Stelle

Zusammenfassung

Molina Healthcare, Inc. is seeking a Registered Nurse to support care management and care coordination activities. You will collaborate with a multidisciplinary team to deliver integrated member care across the continuum, aiming for quality outcomes and cost-effective services.

A strong emphasis on HIPAA/compliance and EMR usage is required. The role involves comprehensive member assessments, developing care plans with stakeholders, and occasional telephonic, home visits, and in-person care

Qualifikationen

• RN license must be active and unrestricted in the state of practice.
• Minimum 2 years experience in health care, preferably in care management or related settings.
• Understanding of EMR and HIPAA requirements.
• Ability to operate proactively with detail-oriented work.
• Strong communication and interpersonal skills across diverse populations.

Aufgaben

• Completes comprehensive member assessments within regulated timelines to identify care management needs.
• Develops and implements care coordination plans with member, caregiver, physician and support network.
• Conducts telephonic, face-to-face or home visits as required.
• Monitors care plan progress, documents interventions and adjusts goals as needed.
• Maintains ongoing caseload and coordinates services across behavioral health, LTSS and community resources.
• Facilitates ICT meetings and supports multidisciplinary collaboration.
• Provides education and motivational interviewing to support behavior change.
• Addresses barriers to care and offers resources to members.
• May support complex cases and medication reconciliation as needed.
• Travel 25-40% may be required based on state/contractual requirements.

Kenntnisse

Time management

Verbal communication

Written communication

Problem solving

Critical thinking

Independent work

Ausbildung

Registered Nurse (RN) license

Tools

MS Office

EMR systems

Jobbeschreibung

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

Pay Range: $26.41 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.