RN Care Manager - STARS

Molina Healthcare; Everett (WA); On-site; USD 36,000 - 82,000; Full time

Job summary

Molina Healthcare seeks an experienced RN Care Manager to support care management activities and coordinate care across the team to achieve positive member outcomes. The role involves assessments, plan development, and collaboration with physicians, caregivers, and the broader care network.

The position requires an active RN license, strong communication, and the ability to travel 25–40% for local duties, ensuring quality, cost-effective care aligned with HIPAA and EMR standards.

Qualifications

• At least 2 years experience in health care, preferably in care management, 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.
• Understanding of EMR and HIPAA.
• Demonstrated knowledge of community resources.
• Ability to work independently with detail-oriented and proactive approach.

Responsibilities

• Completes comprehensive assessments of members and determines care management eligibility.
• Develops and implements care coordination plans with member and care network.
• Conducts telephonic, face-to-face or home visits as required.
• Monitors care plan effectiveness, documents outcomes and suggests changes.
• Maintains ongoing member caseload with regular outreach.
• Promotes integration of behavioral health, LTSS, and community resources.
• Facilitates ICT meetings and cross-team collaboration.
• Uses motivational interviewing to educate and motivate change.
• Assesses barriers to care and provides care coordination assistance.
• May provide consultation and resources to peers.
• RNs may handle complex cases and medication reconciliation.
• Travel may be required (25–40% locally).

Skills

Care management

Case management

Communication skills

Time management

Problem-solving

Education

Registered Nurse (RN) license

Tools

EMR systems

Microsoft Office

Care management platforms

Job description

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

• Experience closing care gaps (HEDIS measures, medication adherence, HOS surveys).
• Comfort using care management platforms and population health tools.
• Track record of successful member engagement and outreach.
• Understanding of CMS Star Ratings methodology and quality bonus payments.

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 - $59.21 / HOURLY

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