Care Manager (RN)

Molina Healthcare•Long Beach, CA

About The Position

Provides support for care management and care coordination activities, collaborating with a multidisciplinary team to coordinate integrated member care across the continuum. The role strives to help members progress toward desired outcomes and contributes to the strategy of providing quality, cost-effective care. The Care Manager completes comprehensive assessments, determines eligibility for care management, and develops care coordination plans with members, caregivers, physicians, other health care professionals, and support networks. The role monitors plans, maintains an ongoing caseload, supports integration of behavioral health, long-term services and supports, and community resources, and facilitates interdisciplinary care team collaboration. Member contact may be telephonic, face-to-face, or through home visits. The position may involve complex cases, medication regimens, medication reconciliation, and approximately 25–40% local travel based on state or contractual requirements.

Requirements

At least 2 years of health care experience, 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 adapt to varied settings, 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, including the 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 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 determine potential eligibility for care management based on clinical judgment, health or psychosocial changes, and assessment triggers.
Develop and implement care coordination plans with members, caregivers, physicians, health care professionals, and member support networks.
Conduct telephonic, face-to-face, or home visits as required.
Monitor care plans, evaluate their effectiveness, document interventions and goal achievement, and recommend changes.
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.