No longer accepting applications
Transition of Care Coach (RN)
Molina HealthcareAlbuquerque, NM, US30+ days ago
Job type
- Full-time
Job descriptionEnsures safe and appropriate transitions by collaborating with hospital discharge planners, as well as with hospitalists, outpatient providers, facility staff, and family / support network, as needed or at the request of member. Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required. Works with participating ancillary providers, public agencies, or other service providers to make sure necessary services and equipment are in place for a safe transition. Conducts face-to-face visits of all members while in the hospital and home visits of high-risk members post-discharge. Coordinates care and reassesses member's needs using the Coleman Care Transitions Model recommended post-discharge timeline. Educates and supports member focusing on seven primary areas (ToC Pillars) : medication management, use of personal health record, follow up care, signs and symptoms of worsening condition, nutrition, functional needs and or Home and Community-based Services, and advance directives. 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. Facilitates interdisciplinary care team meetings and informal ICT collaboration. 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 will conduct medication reconciliation when needed. 40-50% local travel required. Active, unrestricted State 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. Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
Job Description
JOB DESCRIPTION
\n
Job Summary
\n
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.
\n
KNOWLEDGE / SKILLS / ABILITIES
\n \n
- Follows member throughout a 30-day program that starts at hospital admission and continues through transitions from the acute setting to other settings, including nursing facility placement and private home, with the goal of reduced readmissions.
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n
\n \n
JOB QUALIFICATIONS
\n
Required Education
\n
Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.
\n
Required Experience
\n
1-3 years hospital discharge planning or home health.
\n
Required License, Certification, Association
\n \n
\n
\n \n
Preferred Education
\n
Bachelor's Degree in Nursing
\n
Preferred Experience
\n
3-5 years hospital discharge planning or home health.
\n
Preferred License, Certification, Association
\n
Active, unrestricted Transitions of Care Sub-Specialty Certification and / or Certified Case Manager (CCM)
\n
\n
To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing.
\n
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
Create a job alert for this search
Transition Of Care Coach Rn • Albuquerque, NM, US
Related jobs
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, inc...Show moreLast updated: 7 days ago
Relocation Assistance Available.Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials.Compensation for this role is based on a number of factors, including but not ...Show moreLast updated: 30+ days ago Relocation Assistance Available.Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials.Compensation for this role is based on a number of factors, including but not ...Show moreLast updated: 30+ days ago Relocation Assistance Available.Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials.Compensation for this role is based on a number of factors, including but not ...Show moreLast updated: 30+ days ago Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations.
Department : Behavioral Svcs at M...Show moreLast updated: 30+ days ago Relocation Assistance Available.Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials.Compensation for this role is based on a number of factors, including but not ...Show moreLast updated: 30+ days ago 
Occupational Therapy Team Leader Career Opportunity.Must Hold Occupational Therapy License.Lead with Purpose in Occupational Therapy.
Seeking a career transcending the ordinary? Join Encompass Healt...Show moreLast updated: 20 days ago Relocation Assistance Available.Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials.Compensation for this role is based on a number of factors, including but not ...Show moreLast updated: 30+ days ago 
Cuready Healthcare Staffing is seeking a travel Radiation Therapist for a travel job in Albuquerque, New Mexico.Job Description & Requirements.
Cuready Healthcare Staffing Job ID #17287949.Pay p...Show moreLast updated: 19 days ago Occupational Therapy Team Leader Career Opportunity.Must Hold Occupational Therapy License.Lead with Purpose in Occupational Therapy.
Seeking a career transcending the ordinary? Join Encompass Healt...Show moreLast updated: 20 days ago Occupational Therapy Team Leader Career Opportunity.Must Hold Occupational Therapy License.Lead with Purpose in Occupational Therapy.
Seeking a career transcending the ordinary? Join Encompass Healt...Show moreLast updated: 20 days ago 
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, inc...Show moreLast updated: 20 hours ago
Triage Staffing is seeking a travel nurse RN Long Term Care (LTC) Long Term Care for a travel nursing job in Rio Rancho, New Mexico.
Job Description & Requirements.Travel Long Term Care : Long Te...Show moreLast updated: 27 days ago Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials.Compensation for this role is based on a number of factors, including but not limited to experience, education...Show moreLast updated: 30+ days ago Occupational Therapy Team Leader Career Opportunity.Must Hold Occupational Therapy License.Lead with Purpose in Occupational Therapy.
Seeking a career transcending the ordinary? Join Encompass Healt...Show moreLast updated: 20 days ago Occupational Therapy Team Leader Career Opportunity.Must Hold Occupational Therapy License.Lead with Purpose in Occupational Therapy.
Seeking a career transcending the ordinary? Join Encompass Healt...Show moreLast updated: 20 days ago Relocation Assistance Available.Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials.Compensation for this role is based on a number of factors, including but not ...Show moreLast updated: 30+ days ago Relocation Assistance Available.Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials.Compensation for this role is based on a number of factors, including but not ...Show moreLast updated: 30+ days ago
- Promoted
Transition of Care Coach (RN)
Molina Healthcare CareersRio Rancho, NM, USFull-time
- Promoted
RN Sign On Bonus
University of New Mexico - HospitalsSandia Park, NM, USFull-time
- Promoted
RN HOME HEALTH
University of New Mexico - HospitalsAlgodones, NM, USFull-time
- Promoted
MENTAL HEALTH TECH I
University of New Mexico - HospitalsAlgodones, NM, USFull-time
- Promoted
RN - INPATIENT PSYCH
University of New Mexico - HospitalsAlgodones, NM, USPart-time
- Promoted
RN - INPATIENT SUPERVISOR
University of New Mexico - HospitalsPlacitas, NM, USFull-time
- Promoted
Therapy Team Leader
Encompass Health Rehabilitation Hospital of AlbuquerqueSandia Park, NM, USFull-time
- Promoted
Behavioral Health Nurse
University of New Mexico - HospitalsTijeras, NM, USFull-time
- Promoted
Travel Radiation Therapist
Cuready Healthcare StaffingAlbuquerque, NM, USPermanent
- Promoted
Occupational Therapy Team Leader Career Opportunity
Encompass Health Rehabilitation Hospital of AlbuquerquePlacitas, NM, USFull-time
- Promoted
Occupational Therapist (OT)
Encompass Health Rehabilitation Hospital of AlbuquerqueTijeras, NM, USFull-time
- Promoted
- New!
Transition of Care Coach (RN)
Molina HealthcareAlbuquerque, NM, USFull-time
- Promoted
Travel Nurse RN - Long Term Care (LTC) Long Term Care
Triage StaffingRio Rancho, NM, USFull-time
- Promoted
MENTAL HEALTH TECH
University of New Mexico - HospitalsTijeras, NM, USPart-time
- Promoted
Occupational Therapist Team Leader
Encompass Health Rehabilitation Hospital of AlbuquerquePlacitas, NM, USFull-time
- Promoted
Lead with Purpose in Occupational Therapy
Encompass Health Rehabilitation Hospital of AlbuquerqueBernalillo, NM, USFull-time
- Promoted
Home Health Nurse
University of New Mexico - HospitalsSandia Park, NM, USFull-time
- Promoted
RN CASE MANAGER
University of New Mexico - HospitalsPlacitas, NM, USFull-time