Care Manager; RN

JOB DESCRIPTION

Opportunity for Illinois licensed RN to join Molina as a Case Manager working with our Medicare members who reside in Illinois. You will complete assessments needed for determining the types of services we will provide to them. While this role is telephonic, there may be times that you will have to meet with the member face-to-face. Preference will be given to those candidates with previous experience working with the Medicare population within a managed care organization (MCO) like Molina.

Hours are Monday – Friday, 8 AM – 5 PM CST working from home.

Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, and Teams as well as being confident in moving between different programs to complete the necessary forms and documentation.

Job Summary

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.

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).

Required Qualifications

• 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…