RN Care Manager Complex Pediatric Care REMOTE based in New York

Molina Healthcare•Long Beach, NY

3d•Remote

About The Position

Job Summary The Care Manager provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. This position will be supporting our Complex Pediatric Care Management program. The ideal candidate will bring expertise in pediatric conditions such as asthma, diabetes, and ADHD. Experience supporting medically fragile pediatric populations and children involved in foster care or child welfare systems is strongly preferred. Skilled in closing HEDIS and preventive care gaps through proactive outreach and coordination with members and providers. Integrating medical and behavioral health needs in care planning, along with an understanding of clinical guidelines, social determinants of health, and health equity principles is also beneficial. Case management and managed care experience is preferred. Remote position based in New York A New York RN licensure is required Work schedule Monday - Friday 8:30 AM to 5:00 PM EST. Essential Job Duties Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. Conducts telephonic, face-to-face or home visits as required. Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. Maintains ongoing member caseload for regular outreach and management. Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration. Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. Assesses for barriers to care, provides care coordination and assistance to member to address concerns. May provide consultation, resources and recommendations to peers as needed. Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may conduct medication reconciliation as needed. 25-40% estimated local travel may be required (based upon state/contractual requirements).

Requirements

At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA).
Demonstrated knowledge of community resources.
Ability to operate proactively and demonstrate detail-oriented work.
Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
Ability to work independently, with minimal supervision and self-motivation.
Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
Excellent problem-solving, and critical-thinking skills.
Strong verbal and written communication skills.
Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.

Nice To Haves

Certified Case Manager (CCM).

Responsibilities

Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments.
Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals.
Conducts telephonic, face-to-face or home visits as required.
Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
Maintains ongoing member caseload for regular outreach and management.
Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration.
Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
May provide consultation, resources and recommendations to peers as needed.
Care manager RNs may be assigned complex member cases and medication regimens.
Care manager RNs may conduct medication reconciliation as needed.
25-40% estimated local travel may be required (based upon state/contractual requirements).