JOB DESCRIPTION
Opportunity for a TX licensed RN, residing in Texas, with experience functioning
as a Care Manager working with Complex/Intensive cases. Telephonically you will
complete assessments needed for determining the types of services we need to
provide and managing their care until they are discharged from your service. The
ideal candidate will have experience as a Case Manager within a managed care
organization (MCO) like Molina, but we also consider RNs with a strong
background in complex cases. 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. Excellent computer
skills and attention to detail are very important to multitask between systems
and talking with members on the phone while entering accurate contact notes.
This is a fast-paced position and productivity is important.
Job Summary
Provides support for care management/care coordination long-term services and
supports (LTSS)-specific activities. Collaborates with multidisciplinary team
coordinating integrated delivery of member care across the continuum for members
with high-need potential. 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 member assessments within regulated timelines,
including in-person home visits as required.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• Develops and implements care plans, including a waiver service plan in
collaboration with members, caregivers, physicians and/or other appropriate
health care professionals and member support network to address the member needs
and goals.
• Performs ongoing monitoring of 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 (LTSS) and home and community resources to
enhance continuity of care.
• Assesses for medical necessity and authorizes all appropriate waiver services.
• Evaluates covered benefits and advises appropriately regarding funding
sources.
• Facilitates interdisciplinary care team (ICT) 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 and provides care coordination and assistance to
members to address psycho/social, financial, and medical obstacles concerns.
• Identifies critical incidents and develops prevention plans to assure member
health and welfare.
• 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 of experience in health care, including at least 1 year
experience in care management, managed care, and/or experience in a medical or
behavioral health setting, and at least 1 year of experience working with
persons with disabilities, chronic conditions, substance abuse disorders, and
long-term services and supports (LTSS), or equivalent combination of relevant
education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of
practice.
• In some states, a bachelor's degree in a health care related field may be
required (dependent upon state/contractual requirements).
• Valid and unrestricted driver's license, reliable transportation, and adequate
auto insurance for job related travel requirements, unless otherwise required by
law.
• Ability to operate proactively and demonstrate detail-oriented work.
• Demonstrated knowledge of community resources.
• Ability to work within a variety of settings and adjust style as needed -
working with diverse populations and various personalities and personal
situations.
• Ability to work independently, with minimal supervision and demonstrate
self-motivation.
• Responsiveness in all forms of communication, and ability to remain calm in
high-pressure situations.
• Ability to develop and maintain professional relationships.
• Time-management and prioritization skills, and ability to focus on multiple
projects simultaneously and adapt to change.
• Problem-solving skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
• In some states, must have at least one year of experience working directly
with individuals with substance use disorders.
Preferred Qualifications
• Certified Case Manager (CCM).
• Experience working with populations that receive waiver services.
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