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 ensure members progress toward desired outcomes and contributes to a strategy for delivering quality, cost-effective care. The Care Manager completes assessments, develops and monitors care coordination plans, maintains a member caseload, and connects members with behavioral health, long-term services and supports, and community resources. Contacts may be conducted by telephone, face-to-face, or home visits. The position may involve complex cases and medication regimens, medication reconciliation, and an estimated 25–40% local travel depending on state and 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.
Registered Nurse (RN) with an active, unrestricted 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 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.
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 and 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 determine eligibility for care management using clinical judgment, health or psychosocial changes, and assessment triggers.
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, 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.
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 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.