Registered Nurse Case Manager Complex Pediatric Remote in New York

Internal Number : 2025930

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.

This position will be supporting our Complex Pediatric Case Management program as the MMCO Liaison for Medically Fragile Children .

We are seeking a Registered Nurse with previous Case Management experience, expertise in pediatric care and supports / resources for this population of medically fragile children.

Expertise and knowledge of the unique complex needs (including trauma) of this population. Knowledge of State child serving systems, health homes, and specialty providers responsible for addressing the healthcare needs of medically needy children.

Further details to be discussed during our interview process.

Remote position, must reside in New York and agreeable to work with or have familiarity with upstate and downstate regions .

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

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

years in case management, disease management, managed care or medical or behavioral health settings.

Required License, Certification, Association

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.

New York RN licensure

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

years in case management, disease management, managed care or medical or behavioral health settings.

Preferred License, Certification, Association

Active, unrestricted Certified Case Manager (CCM)

Expertise and knowledge of the unique complex needs (including trauma) of this population.

Knowledge of State child serving systems, health homes, and specialty providers responsible for addressing the healthcare needs of medically needy children.

Expertise in pediatric care and supports / resources for this population of medically fragile children

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 : $ - $ / HOURLY

• Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
1 day ago