Remote Telephonic Case Manager RN

$49,421 - $107,099/Yr

Molina Healthcare - Cayce, SC

Full-time

Remote - Cayce, SC

Insurance Carriers and Related Activities

About the position

The Remote Telephonic Case Manager RN position at Molina Healthcare involves managing a caseload of members enrolled in the DSNIP Medicare Advantage program across Ohio, Kentucky, and South Carolina. The role requires the Registered Nurse to conduct comprehensive assessments, develop and implement case management plans, and facilitate care coordination to ensure quality and cost-effective care for members with high needs. This fast-paced remote position emphasizes excellent computer skills and productivity, with a standard schedule of Monday through Friday, 8:00 AM to 5:00 PM EST, and no weekend or holiday work.

Responsibilities

• Complete comprehensive assessments of members per regulated timelines to determine eligibility for case management.
• Develop and implement a case management plan in collaboration with the member, caregiver, physician, and other healthcare professionals.
• Conduct face-to-face or home visits as required.
• Perform ongoing monitoring of the care plan to evaluate effectiveness and document interventions.
• Maintain an ongoing member caseload for regular outreach and management.
• Promote integration of services for members, including behavioral health care and long-term services.
• Facilitate interdisciplinary care team meetings and informal collaboration.
• Use motivational interviewing to educate and support members during contacts.
• Assess for barriers to care and provide care coordination to address concerns.
• Conduct medication reconciliation when needed.

Requirements

• Graduate from an Accredited School of Nursing.
• Active, unrestricted State Registered Nursing (RN) license in good standing.
• 1-3 years of experience in case management, disease management, managed care, or medical/behavioral health settings.
• Valid driver's license with a good driving record.

Nice-to-haves

• Bachelor's Degree in Nursing (preferred).
• 3-5 years of experience in case management, disease management, managed care, or medical/behavioral health settings (preferred).
• Active, unrestricted Certified Case Manager (CCM) certification (preferred).

Benefits

• Competitive benefits and compensation package.