Care Manager (RN)

Molina Healthcare•Long Beach, CA

6d•Remote

About The Position

This 100% remote Care Manager (RN) role is part of a fast-paced, high-volume auto-dialer team and is described as different from a typical care management role. The position supports care management and care coordination activities and collaborates with a multidisciplinary team to coordinate integrated member care across the continuum. It strives to help members progress toward desired outcomes and contributes to providing quality, cost-effective care. The position prefers candidates in the PST or MST time zones and requires a compact license. The role includes maintaining an ongoing member caseload, assessing member needs, and coordinating services and interventions. It may involve local travel estimated at 25–40%, depending on state or contractual requirements, including telephonic, face-to-face, or home visits as required.

Requirements

Registered Nurse (RN) with an active, unrestricted license in the state of practice; a compact license is required.
At least 2 years of health care experience, preferably in care management or a medical and/or behavioral health setting, or an equivalent combination of relevant education and experience.
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).
Demonstrated knowledge of community resources.
Ability to work proactively and with attention to detail.
Ability to work in varied settings and adjust working style to diverse populations, personalities, and personal situations.
Ability to work independently with minimal supervision and demonstrate self-motivation.
Responsiveness across communication channels 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 simultaneously, and adaptability to change.
Excellent problem-solving and critical-thinking skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office or applicable software programs and ability to navigate online portals and databases.

Nice To Haves

Certified Case Manager (CCM).
PST or MST time zone preferred.

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 care professionals, and member support networks.
Conduct telephonic, face-to-face, or home visits as required.
Monitor care plans, evaluate effectiveness, document interventions and goal achievement, and recommend changes as appropriate.
Maintain an ongoing member caseload for 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 provide care coordination 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, estimated at 25–40%, when required by state or contractual requirements.