Care Manager, Health Management (Remote)

Molina Healthcare•Long Beach, AZ

2d•Remote

About The Position

JOB DESCRIPTION Job Summary Provides support for health management activities within the care management/care coordination functions. Collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum, including behavioral health, long-term care, and population health-related education and services for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties Based on clinical assessment and member reported health care concerns, uses clinical judgment to provide care management or refer members to a higher level of care. Identifies member needs, closes health care gaps, develops action plans and prioritizes goals, and educates members on best practices to manage medical needs. Provides condition-specific education designed to assist members and their families in better understanding specific chronic health conditions, how to manage symptoms to prevent conditions from progressing, and adopting healthy lifestyle behaviors. Provides general member education to assist with self-management goals, disease management or acute conditions, and provide indicated contingency plan. Assesses for barriers to care, and provides care coordination and assistance to members to address concerns. Acts as an advocate for members to guide them through the health care system for transition planning and longitudinal care. Reinforces medication adherence and education; monitors member reactions to medications and treatments. Engages member, family, and caregivers telephonically to ensure that a well coordinated action plan is established and continually assesses health status. Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. Maintains ongoing member caseload for regular outreach and management. Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. May facilitate interdisciplinary care team (ICT) meetings and informal ICT collaboration. Collaborates with registered nurse care managers/leaders as needed or required.

Requirements

At least 2 years experience in health care, including at least 1 year of experience in a direct patient care, and/or managed care, care management, or behavioral health setting, or equivalent combination of relevant education and experience.
Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Practical Counselor (LPC), or Registered Dietician (RD). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
Demonstrated knowledge of community resources.
Proactive and detail-oriented.
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 demonstrate self-motivation.
Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations.
Ability to develop and maintain professional relationships with individuals.
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(s) proficiency.

Nice To Haves

Certified Case Manager (CCM).

Responsibilities

Based on clinical assessment and member reported health care concerns, uses clinical judgment to provide care management or refer members to a higher level of care.
Identifies member needs, closes health care gaps, develops action plans and prioritizes goals, and educates members on best practices to manage medical needs.
Provides condition-specific education designed to assist members and their families in better understanding specific chronic health conditions, how to manage symptoms to prevent conditions from progressing, and adopting healthy lifestyle behaviors.
Provides general member education to assist with self-management goals, disease management or acute conditions, and provide indicated contingency plan.
Assesses for barriers to care, and provides care coordination and assistance to members to address concerns.
Acts as an advocate for members to guide them through the health care system for transition planning and longitudinal care.
Reinforces medication adherence and education; monitors member reactions to medications and treatments.
Engages member, family, and caregivers telephonically to ensure that a well coordinated action plan is established and continually assesses health status.
Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
Maintains ongoing member caseload for regular outreach and management.
Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
May facilitate interdisciplinary care team (ICT) meetings and informal ICT collaboration.
Collaborates with registered nurse care managers/leaders as needed or required.