Care Manager (RN)

Molina Healthcare•Long Beach, WA

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 helps members progress toward desired outcomes and contributes to the delivery of quality, cost-effective care. The Care Manager completes comprehensive assessments, identifies members who may qualify for care management, and develops and implements care coordination plans with members, caregivers, physicians, other health care professionals, and support networks. The role monitors care plans, maintains an ongoing member caseload, promotes integration of behavioral health, long-term services and supports, and community resources, and facilitates interdisciplinary care team collaboration. Contacts may take place by telephone, face-to-face, or home visits. The position may involve complex cases and medication regimens, medication reconciliation, consultation and support for peers, and an estimated 25–40% local travel depending 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 adjust work style across settings and work with diverse populations, personalities, and personal situations.
Ability to work independently with minimal supervision and demonstrate self-motivation.
Responsive 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 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 care management eligibility based on clinical judgment, health or psychosocial changes, and assessment triggers.
Develop and implement care coordination plans with members, caregivers, physicians, other health care professionals, and support networks.
Conduct telephone, face-to-face, or home visits as required.
Monitor care plans, document interventions and goal achievement, evaluate effectiveness, 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 support 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.
Travel locally, estimated at 25–40%, when required by state or contractual requirements.