Care Manager (RN) - Must reside in SC

Molina Healthcare•Long Beach, SC

About The Position

The Care Manager (RN) provides support for care management and care coordination activities, collaborating with a multidisciplinary team to coordinate integrated member care across the continuum. The role works to ensure members progress toward desired outcomes and contributes to Molina Healthcare’s strategy of delivering quality, cost-effective member care. Candidates must reside in South Carolina and hold an active South Carolina RN license. Local travel of approximately 25–40% may be required, depending on state and contractual requirements.

Requirements

At least 2 years of healthcare experience, preferably in care management or a medical and/or behavioral health setting, or an equivalent combination of relevant education and experience.
Registered Nurse (RN) with an active, unrestricted license in the state of practice; candidates must hold an active South Carolina RN license.
Candidates must reside in South Carolina.
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 adapt work style when supporting diverse populations, personalities, and personal situations.
Ability to work independently with minimal supervision and demonstrate self-motivation.
Responsiveness across communication methods 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 the member’s support network.
Conduct telephonic, face-to-face, or home visits as required.
Monitor care plans, evaluate their 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 provide 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%, as required by state or contractual requirements.