Care Manager (RN)

required

JOB DESCRIPTION

Job Summary

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.

JOB

QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor's

Degree in Nursing preferred.

Required Experience

1-3 years in case management, disease management, managed

care or medical or behavioral health settings.

Required License, Certification,

Association

Nevada licensure must

be Active, unrestricted State Registered Nursing (RN) license in

good standing.

• NV is not a compact

state

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.

Prior experience in

Utilization Management and discharge planning.

Preferred License,

Certification, Association

Active, unrestricted Certified Case Manager

(CCM)

Some experience

with Utilization Management processes is also desirable (InterQual,

MCG guidelines)

To all current Molina employees : If you are interested in

applying for this position, please apply through the intranet job

listing.

Molina Healthcare offers a competitive

benefits and compensation package. Molina Healthcare is an Equal

Opportunity Employer (EOE) M / F / D / V.

Pay Range :

$27.73 - $54.06 / HOURLY

• Actual compensation may vary

from posting based on geographic location, work experience,

education and / or skill level.