RN Care Manager - Pediatrics

Molina Healthcare; Long Beach (CA); Remote; USD 60,000 - 90,000; Full time

Job summary

Molina Healthcare is looking for a Registered Nurse (RN) to provide telephonic case management support for the Medicaid population in Kentucky. The role involves assessing patient needs, developing care plans in collaboration with healthcare professionals, and ensuring quality care through ongoing management and support. The ideal candidate will have a Bachelor's degree in Nursing and experience in case management or related settings.

Benefits

Competitive benefits package

Equal Opportunity Employer

Qualifications

• 1-3 years in case management, disease management, or managed care.
• Active, unrestricted State Registered Nursing (RN) license in good standing.
• Valid driver's license with reliable transportation.

Responsibilities

• Conduct comprehensive assessments and develop case management plans.
• Facilitate care team meetings and conduct ongoing monitoring of care plans.
• Promote integration of services for continuity of care.

Skills

Attention to Detail

Multitasking

Communication

Education

Bachelor's Degree in Nursing

Graduate from an Accredited School of Nursing

Job description

JOB DESCRIPTION

For this position we are seeking a (RN) Registered Nurse who lives in Kentucky and must be licensed for the state of Kentucky.

Case Manager RN will work with KY Medicaid population providing telephonic case management support. Pediatric and behavioral health experience strongly preferred. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members and providers on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important.

Home office with internet connectivity of high speed required (Must be able to go into office a couple times of year for meetings)

Schedule: Monday thru Friday 8:00AM to 5:00PM EST. (No Weekends or Holidays)

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to 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

• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment.
• Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
• Conducts face-to-face or home visits as required.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member case load for regular outreach and management.
• Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for Molina members.
• Facilitates interdisciplinary care team 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.
• 25- 40% local travel required.
• RNs provide consultation, recommendations and education as appropriate to non-RN case managers.
• RNs are assigned cases with members who have complex medical conditions and medication regimens
• RNs conduct medication reconciliation when needed.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

1-3 years in case management, disease management, managed care or medical or behavioral health settings.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

3-5 years in case management, disease management, managed care or medical or behavioral health settings.

Preferred License, Certification, Association

Active, unrestricted Certified Case Manager (CCM)

To all current Molina employees: If you are interested in applying for this position, please 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.