RN Care Manager Complex Adult Medical Care Remote in NewYork

JOB DESCRIPTION

Job Summary

The Care

Manager (RN) 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.

This

position will be supporting our Complex Adult Medical Care

Management program. The ideal candidate will bring strong expertise

in chronic disease management, with familiarity in evidence-based

practices for conditions commonly seen; such as hypertension,

diabetes, asthma, COPD, and chronic kidney disease / ESRD. Skilled in

closing HEDIS, preventive care gaps through proactive outreach and

coordination with members / providers. Experience integrating medical

and behavioral health needs in care planning, understanding of

clinical guidelines, social determinants of health, and health

equity principles is also beneficial. Case management and managed

care experience is preferred.

Remote position based in New York

A New

York RN licensure is required

Work schedule

Monday - Friday 8 : 30 AM to 5 : 00 PM EST.

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.

plan in collaboration with member, caregiver, physician and / or

other appropriate health care professionals and member support

network to address member needs and goals.

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.

regular outreach and management.

of services for members including behavioral health, long-term

services and supports (LTSS), and home and community resources to

enhance continuity of care.

interdisciplinary care team (ICT) meetings and informal ICT

collaboration.

Molina clinical guideposts to educate, support and motivate change

during member contacts.

provides care coordination and assistance to member to address

concerns.

recommendations to peers as needed.

may be assigned complex member cases and medication

regimens.

reconciliation as needed.

may be required (based upon state / contractual

requirements).

Required

Qualifications

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.

active and unrestricted in state of practice.

unrestricted driver's license, reliable transportation, and

adequate auto insurance for job related travel requirements, unless

otherwise required by law.

electronic medical record (EMR) and Health Insurance Portability

and Accountability Act (HIPAA).

of community resources.

and demonstrate detail-oriented work.

within a variety of settings and adjust style as needed - working

with diverse populations, various personalities and personal

situations.

supervision and self-motivation.

forms of communication, and ability to remain calm in high-pressure

situations.

professional relationships.

and prioritization skills, and ability to focus on multiple

projects simultaneously and adapt to change.

problem-solving, and critical-thinking skills.

verbal and written communication skills.

Office suite / applicable software program proficiency, and ability

to navigate online portals and

databases.

Preferred

Qualifications

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

Pay Range : $26.41 - $61.79 / HOURLY

geographic location, work experience, education and / or skill

level.