RN Case Manager - Community Well

Molina Healthcare • Warren, MI

128d • $26 - $51

About The Position

For this position we are seeking a RN who must live and have a current active unrestricted license (RN) in the state of MI. This position will support our MMP (Medicaid Medicare Population) that is part of the Community Well team. This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent computer skills and diligence are especially important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. Home office with internet connectivity of high speed required. TRAVEL in the field to do member visits in the surrounding areas will be required: (Warren, Detroit, Clinton Township MI) Travel will be up to 20% of the time (Mileage is reimbursed) Schedule: Monday thru Friday 8:30AM to 5:00PM.

Requirements

• Graduate from an Accredited School of Nursing.
• At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports.
• 1-3 years in case management, disease management, managed care or medical or behavioral health settings.
• Active, unrestricted State Registered Nursing license (RN) in good standing.
• Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Nice To Haves

• Bachelor's Degree in Nursing.
• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.
• 1 year experience working with population who receive waiver services.
• Active and unrestricted Certified Case Manager (CCM).

Responsibilities

• Completes face-to-face comprehensive assessments of members per regulated timelines.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members.
• Assesses for medical necessity and authorize all appropriate waiver services.
• Evaluates covered benefits and advise appropriately regarding funding source.
• Conducts face-to-face or home visits as required.
• Facilitates interdisciplinary care team meetings for approval or denial of services 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 psycho/social, financial, and medical obstacles concerns.
• Identifies critical incidents and develops prevention plans to assure member's health and welfare.
• Provides consultation, recommendations and education as appropriate to non-RN case managers.
• Works cases with members who have complex medical conditions and medication regimens.
• Conducts medication reconciliation when needed.

Benefits

• Competitive benefits and compensation package.

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree