RN Care Manager Complex Pediatric Care REMOTE based in New York

JOB DESCRIPTION

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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 Pediatric Care Management program. The ideal candidate will bring expertise in pediatric conditions such as asthma, diabetes, and ADHD. Skilled in closing HEDIS and preventive care gaps through proactive outreach and coordination with members and providers. Experience integrating medical and behavioral health needs in care planning, along with an 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.
• Develops and implements care coordination plan in collaboration with member, caregiver, physician and / or other appropriate health care professionals and member support network to address member needs and goals.
• Conducts 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.
• Maintains ongoing member caseload for regular outreach and management.
• Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
• Facilitates interdisciplinary care team (ICT) 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.
• May provide consultation, resources and recommendations to peers as needed.
• Care manager RNs may be assigned complex member cases and medication regimens.
• Care manager RNs may conduct medication reconciliation as needed.
• 25-40% estimated local travel may be required (based upon state / contractual requirements).

Required Qualifications

Preferred Qualifications

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

Remote working / work at home options are available for this role.