Care Manager (RN) - Must reside in SC

Molina Healthcare•Long Beach, CA

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. Works to ensure members progress toward desired outcomes and contributes to the strategy of providing quality, cost-effective member care. Candidates must reside in South Carolina and hold an active South Carolina RN license. The role may require an estimated 25–40% local travel, based on state and contractual requirements.

Requirements

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.
Registered Nurse (RN) with an active, unrestricted license in the state of practice; this position requires an active South Carolina RN license.
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 adjust work style 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 focus on multiple projects simultaneously and adapt to change.
Excellent problem-solving and critical-thinking skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office and applicable software programs, 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 care management eligibility.
Develop and implement care coordination plans with members, caregivers, physicians, other appropriate health care professionals, and the member's support network.
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 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.