Molina Healthcare is hiring a remote RN Care Manager for our Washington State
Health Plan. This role is remote, however there is a preference (not
requirement) 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 Managed Care Organization is highly
desired.
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 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 a competitive benefits and compensation package. Molina
Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V