Remote Care Manager (Rn) - Must Live In Texas

Molina Healthcare; San Antonio (TX); Remote; USD 43,000 - 70,000; Full time

Job summary

Molina Healthcare in Texas seeks six Texas-licensed RNs to work telephonically with Medicaid members across the state. Most interactions are telephonic; rare in-person visits may occur. Two tracks require at least two years in behavioral health or substance use; two require ICU/ER experience.

Hours are Monday–Friday, 8 AM–5 PM in your time zone. Bilingual candidates are a plus. As a care manager RN, you will support care coordination, collaborate with a multidisciplinary team, and monitor member

Qualifications

• At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Valid and unrestricted driver's license and reliable transportation for travel requirements.
• Understanding of EMR and HIPAA regulation.

Responsibilities

• Completes comprehensive assessments of members per regulated timelines and determines eligibility for care management.
• Develops and implements care coordination plans with members, caregivers, and health professionals.
• Conducts telephonic, in-person, or home visits as required.
• Monitors and adjusts care plans based on outcomes and ongoing needs.
• Maintains ongoing member caseload and coordinates services across behavioral health, LTSS, and community resources.
• Facilitates interdisciplinary care team meetings and supports team collaboration.

Skills

Care coordination

Communication

EMR/HIPAA knowledge

Time management

Motivational interviewing

Interdisciplinary collaboration

Education

RN license

Tools

Outlook

Excel

Teams

OneNote

EMR systems

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.
• 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.