RN Care Manager; Telephonic

JOB DESCRIPTION

For this position we are seeking a (RN) Registered Nurse who is licensed in the state of South Carolina or holds a compact license. The Care Manager RN will work with the Medicaid/Medicare SC population, completing assessments, developing care plans, educating members, and connecting them to community resources. Excellent computer skills, attention to detail, and the ability to multitask between systems while maintaining accurate contact notes are essential.

The role is fast‑paced and productivity is a priority.

Preferred experience working with a Behavioral Health population and/or Waiver program.

Home office with high‑speed internet connectivity is required. This is a remote position.

Schedule:

Monday thru Friday 8:00 AM to 5:00 PM EST (flexibility to work 1–2 nights a week until 6:00 PM EST). No weekends or holidays.

Provides support for care management/care coordination activities and collaborates with a multidisciplinary team to coordinate 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.

• 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 plans in collaboration with member, caregiver, physician, and 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 plans 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 barriers to care, provides care coordination and assistance to members 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).

• At least 2 years of experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or an equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in the 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.

• Certified Case Manager (CCM).

To all current Molina employees:
If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $26.41 – $61.79 / HOURLY

* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.