Care Manager (RN)

Molina Healthcare•Long Beach, FL

10d

About The Position

The Care Manager (RN) provides support for care management and care coordination activities and collaborates 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 the strategy of providing quality, cost-effective care. The position manages a member caseload, conducts assessments and outreach, develops and monitors care coordination plans, and promotes integration of health and community services. Contact may be by phone, face-to-face, or home visit as required. Local travel of an estimated 25–40% may be required, based on state or contractual requirements. Care Manager RNs may be assigned complex cases and medication regimens, and may conduct medication reconciliation as needed.

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 adjust working style across 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, with 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 use clinical judgment, changes in health or psychosocial wellness, and assessment triggers to determine potential care management eligibility.
Develop and implement care coordination plans with members, caregivers, physicians, other appropriate health professionals, and 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 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 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.
Travel locally, estimated at 25–40%, when required by state or contractual requirements.