Remote Care Manager (RN) - MUST LIVE IN TEXAS

Molina Healthcare Careers; San Antonio (TX); Hybrid; USD 36,000 - 71,000; Full time

Job summary

Molina Healthcare Careers seeks six TX-licensed RNs to work telephonically with Medicaid members across Texas. Roles include behavioral health or ICU/ED experience, with potential in-person meetings. Primary duties are telephonic care management, with occasional member visits and travel.

Experience with Microsoft Office and EMR/HIPAA is required. Bilingual is a plus, and prior managed care case management experience is favored.

Qualifications

• At least 2 years in health care, preferably care management or related setting.
• RN license active and unrestricted in state of practice.
• Valid driver’s license and reliable transportation for travel requirements.
• Understanding of EMR and HIPAA.
• Ability to work independently and manage multiple priorities.

Responsibilities

• Complete comprehensive member assessments per timelines to identify care management eligibility.
• Develop and implement care coordination plans with members, families, and providers.
• Conduct telephonic or in-person visits as needed.
• Monitor and document progress toward outcomes and adjust plans accordingly.
• Maintain ongoing member caseload with proactive outreach and engagement.
• Promote integration of behavioral health, LTSS and community resources.
• Facilitate ICT meetings and collaborate with the care team.
• Educate and motivate members using motivational interviewing and clinical guidelines.
• Identify barriers to care and provide necessary coordination and support.
• May assist peers with consultation and resource recommendations.
• Care manager RNs may handle complex cases and medication regimens.
• May conduct medication reconciliation as needed.
• Travel 25–40% may be required.

Skills

Care coordination

EMR/HIPAA

Communication

Team collaboration

Time management

Education

Registered Nurse (RN) license

Tools

Microsoft Office

Outlook

Excel

Teams

OneNote

Job description

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.


• Assess 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.