Care Manager (RN)

Molina Healthcare•Long Beach, OH

11d

About The Position

Provides support for care management and care coordination activities and collaborates with a multidisciplinary team to coordinate integrated delivery of 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 maintains an ongoing member caseload and may involve complex cases and medication regimens. Conducts telephonic, face-to-face, or home visits as required. An estimated 25–40% local travel may be required, based on state or contractual requirements.

Requirements

At least 2 years of experience in health care, preferably in care management or 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).
Demonstrated 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.
Responsive 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 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, 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, health or psychosocial changes, 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 members’ 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.