Care Manager (RN)

Molina Healthcare•Long Beach, MI

About The Position

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 strives to ensure member progress toward desired outcomes and contributes to the strategy of providing quality, cost-effective member care. Care Manager RNs may be assigned complex member cases and medication regimens and may conduct medication reconciliation as needed. Local travel of approximately 25–40% may be required, depending on state and contractual requirements.

Requirements

At least 2 years of health care experience, preferably in care management or 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 approach when working 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.
Strong time-management and prioritization skills; ability to manage multiple projects and adapt to change.
Strong 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 health professionals, and member support networks to address 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 suggest 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 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 provide 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.