RN Care Manager - STARS

Molina Healthcare; United States; On-site; USD 41,328 - 81,278; Full time

Job summary

Molina Healthcare seeks an experienced RN Care Manager to support care coordination across the continuum. The role involves assessing member needs, designing care plans, and collaborating with an interdisciplinary team to ensure high-quality, cost-effective care.

The position requires a valid RN license, EMR proficiency, and ability to travel up to 40%. Strong communication and time-management skills are essential to succeed in a dynamic healthcare environment.

Qualifications

• Active RN license required.
• Experience in health care, care management or related setting preferred.
• Knowledge of EMR and HIPAA regulations.

Responsibilities

• Conduct comprehensive member assessments and determine eligibility for care management.
• Develop and implement collaborative care coordination plans with care team and stakeholders.
• Perform telephonic, in-person, or home visits as needed.
• Monitor and document progress toward goals; adjust plans as necessary.
• Maintain ongoing member caseload with proactive outreach.
• Promote integration of behavioral health, LTSS, and community resources.
• Facilitate interdisciplinary care team meetings and collaboration.
• Educate and motivate members using motivational interviewing.
• Identify barriers to care and provide coordination support.
• May provide peer consultation and recommendations as needed.
• Travel 25–40% depending on state/contractual requirements.

Skills

RN (Active)

Care coordination

EMR knowledge

HIPAA knowledge

Time management

Verbal & written communication

MS Office proficiency

Travel readiness

Education

Nursing degree (RN)

Tools

EMR systems

MS Office

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 judgement, 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).

Benefits and Compensation

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.