Telephonic Case Manager (RN) - Illinois ONLY

ClickJobs.io; Rockford (IL); Remote; USD 60,000 - 80,000; Full time

Job summary

Join a leading healthcare organization as a Case Manager, working remotely with Medicaid members. Utilize your nursing expertise to conduct assessments, develop care plans, and ensure high-quality care for patients with complex medical needs. This role requires strong case management skills and offers a competitive pay range.

Benefits

Competitive benefits and compensation package

Qualifications

• 1-3 years in case management, disease management, or managed care.
• Active, unrestricted State Registered Nursing (RN) license required.

Responsibilities

• Conduct assessments to determine case management needs.
• Develop and implement case management plans with healthcare professionals.
• Maintain ongoing member case load for regular outreach.

Skills

Microsoft Office Suite

Motivational Interviewing

Education

Bachelor's Degree in Nursing

Tools

Clinical Documentation Software

Job description

JOB DESCRIPTION

Opportunity to join Molina Healthcare working with our Medicaid members as a Case Manager. This is open to Illinois licensed RNs across the state who have experience working with patients with respiratory diagnosis like asthma, pulmonary hypertension, or COPD. This is a fully remote opportunity conducting assessments by phone to determine the resources we need to provide as well as case management for the member. Our ideal applicant would be someone who has experience doing case management/discharge planning in a managed care organization (MCO) like Molina and has been a RN for at least 5 years. Hours are Monday – Friday, 8AM – 5PM CST.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, Teams, and One Note as well as experience using a clinical documentation software program.

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.

Pay Range: $27.73 - $54.06 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.