Care Manager (RN)

Molina Healthcare•Long Beach, CA

About The Position

The Care Manager (RN) supports 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 delivery of quality, cost-effective care. The Care Manager assesses members, identifies those who may qualify for care management, and develops and monitors care coordination plans in collaboration with members, caregivers, physicians, other health care professionals, and support networks. The role maintains a caseload, coordinates services and resources, facilitates interdisciplinary care team collaboration, and uses motivational interviewing and clinical guidance to support members. Work may include complex cases, medication regimens, and medication reconciliation. Telephonic, in-person, or home visits may be required, along with an estimated 25–40% local travel depending on state or contractual requirements.

Requirements

At least 2 years of experience in health care, preferably in care management or 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.
Responsiveness across communication channels and ability to remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Strong time-management and prioritization skills, with 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).
Experience working with behavioral health conditions, including serious mental illness, anxiety, depression, substance use disorders, and/or co-occurring medical and behavioral health needs.

Responsibilities

Complete comprehensive member assessments within regulated timelines and use clinical judgment, changes in health or psychosocial wellness, and assessment triggers to identify potential eligibility for care management.
Develop and implement care coordination plans with members, caregivers, physicians, other appropriate health care professionals, and member 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.
Travel locally as required, estimated at 25–40% based on state or contractual requirements.