Care Manager (RN) - Volusia County, FL

Molina Healthcare•United States,

3d•$24 - $51

About The Position

Provides support for care management and care coordination activities and collaborates with a multidisciplinary team to coordinate integrated member care across the continuum. The Care Manager strives to ensure members progress toward desired outcomes and contributes to the strategy of providing quality, cost-effective care. The role includes completing comprehensive assessments, developing and monitoring care coordination plans, maintaining a member caseload, and coordinating services across behavioral health, long-term services and supports, and home and community resources. Contacts may be telephonic, face-to-face, or conducted through home visits as required. The position may involve complex cases and medication regimens, medication reconciliation, consultation with peers, and an estimated 25–40% local travel based on state or contractual requirements.

Requirements

At least 2 years of experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or an equivalent combination of relevant education and experience.
Active, unrestricted Registered Nurse (RN) license in the state of practice.
Valid, unrestricted driver's license, reliable transportation, and adequate auto insurance for job-related travel, unless otherwise required by law.
Understanding of electronic medical records (EMR) and the Health Insurance Portability and Accountability Act (HIPAA).
Knowledge of community resources.
Ability to work proactively and with attention to detail.
Ability to work in varied settings and adjust approach when working with diverse populations, 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.
Excellent time-management and prioritization skills; ability to manage multiple projects and adapt to change.
Excellent problem-solving and critical-thinking skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office and applicable software, and ability to navigate online portals and databases.

Nice To Haves

Certified Case Manager (CCM).

Responsibilities

Complete comprehensive member assessments within regulated timelines and use clinical judgment, changes in health or psychosocial wellness, and assessment triggers to determine potential eligibility for care management.
Develop and implement care coordination plans with members, caregivers, physicians, other appropriate health professionals, and member support networks.
Conduct telephonic, face-to-face, or home visits as required.
Monitor care plans on an ongoing basis, evaluate effectiveness, document interventions and goal achievement, and recommend changes as appropriate.
Maintain an ongoing member caseload and conduct regular outreach and management.
Promote integration of behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
Facilitate interdisciplinary care team (ICT) meetings and informal ICT collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Assess barriers to care and coordinate care and assistance to address member concerns.
Provide consultation, resources, and recommendations to peers as needed.
Manage complex member cases and medication regimens when assigned.
Conduct medication reconciliation as needed.
Travel locally as required; estimated travel may be 25–40% based on state or contractual requirements.