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RN Case Manager at Molina Healthcare

JOB FUNCTION:
Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential.  HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE, SKILLS & ABILITIES:

  • Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member’s health or psychosocial wellness, and triggers identified in the assessment.
  • Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member’s support network to address the member needs and goals.
  • Conducts face-to-face or home visits as required.
  • Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
  • Maintains ongoing member case load for regular outreach and management.
  • Promotes integration of services for members including behavioral health care and long term services and supports/home and community  to enhance the continuity of care for Molina members.
  • Facilitates interdisciplinary care team 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.
  • 25- 40% local travel required.
  • RNs provide consultation, recommendations and education as appropriate to non-RN case managers.
  • RNs are assigned cases with members who have complex medical conditions and medication regimens.
  • RNs conduct medication reconciliation when needed.

REQUIRED EDUCATION:
Graduate from an Accredited School of Nursing.

REQUIRED EXPERIENCE:
1-3 years in case management, disease management, managed care or medical or behavioral health settings.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

  • Active, unrestricted Texas Registered Nursing (RN) license in good standing.
  • Must have valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation.

PREFERRED EDUCATION:
Bachelor’s Degree in Nursing

PREFERRED EXPERIENCE:
3-5 years in case management, disease management, managed care or medical or behavioral health settings.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
Certified Case Manager (CCM)

PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full TimePosting Date: 02/11/2021

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