RN Care Manager - STARS

Molina Healthcare; Worcester (MA); On-site; USD 41,328 - 81,278; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare in Massachusetts is seeking a Nurse Care Manager to coordinate member care across the continuum. The RN will assess, plan, implement, and monitor care with a multidisciplinary team to achieve outcomes and optimize quality and cost‑effective services.

Travel may be required (local), you’ll collaborate with care teams, use motivational interviewing, and navigate EMR systems while maintaining HIPAA compliance.

Qualifications

• At least 2 years experience in health care, preferably in care management.
• Registered Nurse (RN) license active in state of practice.
• Valid driver's license, reliable transportation, and auto insurance for travel.
• Understanding of EMR systems and HIPAA.
• Knowledge of community resources and ability to work independently.
• Excellent time management and communication skills.

Responsibilities

• Completes comprehensive assessments of members and determines eligibility for care management.
• Develops and implements care coordination plan with member and care team.
• Conducts telephonic, face-to-face or home visits as required.
• Monitors care plan effectiveness, documents interventions, and updates accordingly.
• Maintains ongoing member caseload and outreach.
• Promotes integration of services including behavioral health and LTSS.
• Facilitates ICT meetings and collaboration.
• Uses motivational interviewing and Molina guidelines to educate and motivate change.
• Assesses barriers to care and provides coordination assistance.
• May provide consultation to peers as needed.
• Care manager RNs may manage complex cases and med reconciliation.
• May require 25-40% local travel.

Skills

Registered Nurse (RN)

Driver's license

HIPAA knowledge

EMR familiarity

Community resources knowledge

Independent worker

Time management

Communication skills

Education

RN License

Tools

EMR software

Microsoft Office

Job description

JOB DESCRIPTION Job Summary

Provides support for care management/care coordination activities and collaborates with a 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: $30.37 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.