Care Manager (RN)

Molina Healthcare•Long Beach, CA

11d

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 works to ensure members progress toward desired outcomes and contributes to the strategy of providing quality, cost-effective care. The Care Manager completes comprehensive assessments, develops and monitors care plans with members and their support networks, and coordinates services across behavioral health, long-term services and supports, and community resources. The role maintains a member caseload and conducts outreach through telephone, face-to-face, or home visits as required. Local travel of approximately 25–40% may be required, depending on state and contractual requirements. Care Manager RNs may be assigned complex cases and medication regimens and may conduct medication reconciliation.

Requirements

At least 2 years of experience in health care, preferably in care management or a medical 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 HIPAA.
Knowledge of community resources.
Ability to work proactively and with attention to detail.
Ability to adapt to varied 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.
Strong time-management and prioritization skills; ability to handle multiple projects and adapt to change.
Strong 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.
Ability to meet local travel requirements, estimated at 25–40% where applicable.

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.
Conduct telephonic, face-to-face, or home visits as required.
Monitor care plans, document interventions and goal achievement, evaluate effectiveness, and recommend changes.
Maintain a member caseload for regular outreach and management.
Promote integration of behavioral health, long-term services and supports, and home and community resources to enhance continuity of care.
Facilitate interdisciplinary care team meetings and informal collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate members during contacts.
Assess barriers to care and coordinate services 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.