Care Manager (RN)

Molina Healthcare•Long Beach, WA

6d•Hybrid

About The Position

The Care Manager 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 help members progress toward desired outcomes and contributes to Molina Healthcare’s strategy for delivering quality, cost-effective care. This is a hybrid role with approximately 10% local travel within King County stated in the description; the duties also note that 25–40% estimated local travel may be required based on state or contractual requirements. The role includes managing a caseload of 30–35 members and requires care management experience in Pediatrics, NICU, or Private Duty Nursing, as well as prior remote care management or clinical-setting experience. The position supports pediatric populations and may involve complex cases and medication regimens.

Requirements

At least 2 years of experience in health care, preferably in care management, or experience 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 adapt to 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 manage multiple projects simultaneously 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.
Prior experience working remotely in a care management or clinical setting.
Care management experience in Pediatrics, NICU, or Private Duty Nursing.

Nice To Haves

Certified Case Manager (CCM).

Responsibilities

Complete comprehensive member assessments within regulated timelines and determine eligibility for care management using clinical judgment, changes in health or psychosocial wellness, and assessment triggers.
Develop and implement care coordination plans with members, caregivers, physicians, other health professionals, and support networks to address member needs and goals.
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 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 coordinate care 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.