RN Care Manager - STARS

Molina Healthcare; Boston (MA); On-site; USD 41,837 - 81,567; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is seeking an experienced RN to join our care management team in the Boston area. The role focuses on coordinating member care across disciplines, developing care plans, and supporting progress toward outcomes within a regulated healthcare environment.

Responsibilities include assessments, plan implementation, home visits as required, and collaboration with clinicians, caregivers and community resources to ensure seamless, cost‑effective care delivery for members.

Qualifications

• At least 2 years experience in health care, care management, or related field.
• RN license active and unrestricted in state of practice.
• Valid driver's license and ability to travel as required.
• Understanding of EMR and HIPAA regulations.
• Knowledge of community resources and patient advocacy.
• Ability to work independently with proactive, detail oriented approach.
• Strong time management and prioritization skills.

Responsibilities

• Completes comprehensive member assessments within regulated timelines.
• Develops and implements care coordination plans with the care team.
• Conducts telephonic, in-person, or home visits as needed.
• Monitors care plan effectiveness and documents interventions.
• Maintains ongoing member caseload with regular outreach.
• Promotes integration of services across behavioral health and LTSS.
• Facilitates ICT meetings and supports team collaboration.
• Educates and motivates members using motivational interviewing.
• Addresses barriers to care and provides resources as needed.
• May provide consultation to peers and perform medication reconciliation.

Skills

RN license

healthcare experience

EMR proficiency

HIPAA knowledge

communication

time management

problem solving

MS Office

Tools

EMR/EHR systems

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.
• 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: $30.37 - $59.21 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.