A natural match if you have experience in care management within a managed care organization (MCO).
Derived from job-description analysis by Serendipath's career intelligence engine.
Original posting from Molina Healthcare
Molina Healthcare is hiring a remote RN Care Manager. Preference for candidates in Washington State. This role will be working Pacific Standard Time hours.
This role supports Medicare members through telephonic case management and transition-of-care functions, with no current travel, direct patient care, weekends, holidays, or night work.
Previous RN Care Management experience at an MCO highly desired.
Essential Job Duties
- 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.
- 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 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.
Preferred Qualifications
- 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 competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Key Words: Discharge Planning, Home Health, MCG Guidelines, Social Services, Health Care Navigator, Discharge Planner, Care Manager, Case Manager, LVN, LPN, Licensed Vocational Nurse, Licensed Practical Nurse, Continuity of Care, Transition of Care / Transitional Care, Interdisciplinary Collaboration / Multidisciplinary Team, Comprehensive Patient Assessment, Acuity & Functional Assessment, Medication Reconciliation, Patient & Caregiver Education, Post-Acute & Resource Coordination, Durable Medical Equipment (DME), Home Health Care / Home Care Services, Skilled Nursing Facility (SNF) Placement, Inpatient Rehabilitation / Long-Term Acute Care (LTAC), Community Resource Linkage / Utilization, Transportation & Follow-up Scheduling, Compliance, Payors & Quality Metrics, Medicare / Medicaid Guidelines, Condition of Participation (CoP), Readmission Prevention / Reducing 30-Day Readmissions, Utilization Review (UR) / Case Management, Insurance Verification & Payor Source Management, HIPAA Compliance & Confidentiality
Source: Molina Healthcare careers