Remote Care Manager (RN) - MUST LIVE IN TEXAS

Molina Healthcare; Clifton (TX); À distance; USD 60 000 - 85 000; Plein temps

Résumé du poste

Molina Healthcare is seeking six TX licensed RNs to support Medicaid members telephonically across the state. Roles include care management with 2+ years in BH/SA or ICU/ED, telephonic coordination, and occasional in-person visits. Hours are Mon–Fri, 8–5 in your time zone. Bilingual a plus and prior MCO experience is favored.

Solid MS Office skills, especially Outlook, Excel, Teams, and OneNote, are required as part of daily collaboration and documentation.

Qualifications

• Minimum 2 years of health care experience; care management preferred.
• RN license active and unrestricted in Texas.
• Valid driver's license and reliable transportation.
• Proficiency with EMR and HIPAA.
• Bilingual a plus.

Responsabilités

• Complete comprehensive assessments within regulated timelines and determine eligibility for care management.
• Develop and implement care coordination plan with member, caregiver, physician and team.
• Conduct telephonic, face-to-face or home visits as required.
• Monitor care plan for effectiveness, document interventions and adjust as needed.
• Maintain ongoing member caseload for regular outreach.
• Promote integration of behavioral health, LTSS and home/community resources.
• Facilitate ICT meetings and collaboration.
• Use motivational interviewing and Molina guidelines to educate and support change.
• Assess barriers to care and provide care coordination to address concerns.
• May provide consultation to peers as needed.
• Care manager RNs may handle complex cases and medications reconciliation.
• Travel 25-40% may be required.

Connaissances

Care management experience

EMR/HIPAA knowledge

Microsoft Office (Outlook, Excel,Teams

Formation

RN license active in Texas

CCM certification (preferred)

Outils

Outlook

Excel

Teams

OneNote

Description du poste

JOB DESCRIPTION

We are searching for six TX licensed RNs to work telephonically with our Medicaid members across the state. Three of the positions are open to RNs with at least two years of experience in in Behavioral Health or Substance Abuse Disorder in any type of setting; the other three should have at least two years of experience working in ICU, CCU, or Emergency Department. The members supported by these care managers have complex mental health diagnosis and/or complex health diagnosis and comorbidities. Most of the responsibilities will be managed telephonically, but there may be rare instances where meeting with a member in person may be needed. Hours are Monday – Friday, 8 AM – 5 PM in your time zone. Preference will be given to RNs who have been employed by another managed care organization as a case manager. Bilingual is a plus.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, Teams, and One Note.

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