Talent.com
Transition of Care Coach (RN) (Pacific Business hours)

Transition of Care Coach (RN) (Pacific Business hours)

Molina HealthcareGrand Rapids, MI, United States
18 days ago
Job type
  • Full-time
Job description

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

  • 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.
  • Ensures 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.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

1-3 years hospital discharge planning or home health.

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.
  • CALIFORNIA State Specific Requirements : Must be licensed currently for the state of California. California is not a compact state.

    Preferred Education

    Bachelor's Degree in Nursing

    Preferred Experience

    3-5 years hospital discharge planning or home health.

    Preferred License, Certification, Association

    Active, unrestricted Transitions of Care Sub-Specialty Certification and / or Certified Case Manager (CCM)

  • Work schedule : M - F Pacific Business Hours
  • Candidates can live anywhere in the USA but must work PACIFIC hours.

    California  or West Coast USA Residents preferred

  • Remote, no travel required.
  • 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 : $30.37 - $51.49 / HOURLY

  • Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
  • Create a job alert for this search

    Transition Of Care • Grand Rapids, MI, United States

    Related jobs
    • Promoted
    Transition of Care Coach (RN)

    Transition of Care Coach (RN)

    Molina HealthcareGrand Rapids, MI, United States
    Full-time
    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: 18 days ago
    • Promoted
    Assistant Director of Nursing (ADON)

    Assistant Director of Nursing (ADON)

    Regency at FremontFREMONT, MI, United States
    Full-time
    Are you a Registered Nurse (RN) looking for a leadership opportunity with a growing organization? We have an exceptional opportunity for an Assistant Director of Nursing (ADON) to join our team at ...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - Labor and Delivery

    Travel Nurse RN - Labor and Delivery

    LanceSoftFremont, MI, US
    Permanent
    LanceSoft is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Fremont, Michigan.Job Description & Requirements. Job Specific Information : Labor and Delivery, Couplet Care...Show moreLast updated: 6 days ago
    • Promoted
    CRNA - Anesthesiology job available in Fremont, Michigan

    CRNA - Anesthesiology job available in Fremont, Michigan

    NorthStar AnesthesiaFremont, MI, US
    Full-time
    Get the Recognition Youve Earned.Build Your Future with NorthStar.Join NorthStar Anesthesia as we continue our exciting nationwide expansion! Were seeking passionate CRNAs to help deliver excellenc...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - Medical-Surgical - $2,771 per week in Fremont, MI

    Travel Nurse RN - Medical-Surgical - $2,771 per week in Fremont, MI

    TravelNurseSourceFremont, MI, US
    Full-time +1
    TravelNurseSource is working with AHS Staffing to find a qualified Med / Surg RN in Fremont, Michigan, 49412!.AHS Staffing is looking for a Med - Surg Registered Nurse in Fremont, MI for a Long Term ...Show moreLast updated: 4 days ago
    • Promoted
    Travel Home Health Physical Therapist

    Travel Home Health Physical Therapist

    Core Medical GroupGrand Rapids, MI, US
    Permanent +1
    Core Medical Group is seeking a travel Home Health Physical Therapist for a travel job in Grand Rapids, Michigan.Job Description & Requirements. Client in MI seeking Physical Therapist.We are lo...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Physical Therapist

    Travel Physical Therapist

    KPG AlliedGrand Rapids, MI, US
    Permanent
    KPG Allied is seeking a travel Physical Therapist for a travel job in Grand Rapids, Michigan.Job Description & Requirements. Candidates must have at least 1 years of paid experience in the last ...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Labor and Delivery Registered Nurse

    Travel Labor and Delivery Registered Nurse

    Medical SolutionsFremont, MI, US
    Full-time
    Medical Solutions is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Fremont, Michigan.Job Description & Requirements. We’re seeking talented healthcare profession...Show moreLast updated: 6 days ago
    • Promoted
    Travel Physical Therapist - $2,822 per week

    Travel Physical Therapist - $2,822 per week

    Healthcare SupportGrand Rapids, MI, United States
    Full-time +1
    Healthcare Support is seeking a travel Physical Therapist for a travel job in Grand Rapids, Michigan.Job Description & Requirements. Healthcare Support Job ID #473515.Pay package is based on 8 hour ...Show moreLast updated: 10 days ago
    • Promoted
    Staff Development Coordinator RN

    Staff Development Coordinator RN

    Regency at FremontFREMONT, Michigan, United States
    Full-time
    Are you a nurse who is passionate about teaching others? The Staff Development Coordinator acts as the educator for Regency at Fremont, conducts orientation and has the opportunity to provide other...Show moreLast updated: 30+ days ago
    • Promoted
    Unit Manager - Sign On Bonus

    Unit Manager - Sign On Bonus

    The Laurels of HudsonvilleHUDSONVILLE, Michigan, United States
    Full-time
    Are you an RN looking for a leadership role? Do you have a passion for leading and teaching other skilled nursing staff? The RN Unit Manager provides, plans, coordinates or manages nursing care and...Show moreLast updated: 6 days ago
    • Promoted
    Unit Manager

    Unit Manager

    The Laurels of HudsonvilleHUDSONVILLE, Michigan, United States
    Full-time
    Are you an RN looking for a leadership role? Do you have a passion for leading and teaching other skilled nursing staff? The RN Unit Manager provides, plans, coordinates or manages nursing care and...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - Labor and Delivery

    Travel Nurse RN - Labor and Delivery

    PRN HealthcareFremont, MI, US
    Full-time
    PRN Healthcare is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Fremont, Michigan.Job Description & Requirements. PRN Healthcare Job ID #1450881.Pay package is based o...Show moreLast updated: 6 days ago
    • Promoted
    Travel Nurse RN - Emergency Room (ER) / Trauma - $1,914 to $2,109 per week in Fremont, MI

    Travel Nurse RN - Emergency Room (ER) / Trauma - $1,914 to $2,109 per week in Fremont, MI

    TravelNurseSourceFREMONT, MI, US
    Full-time
    TravelNurseSource is working with AMN Healthcare to find a qualified ER / Trauma RN in FREMONT, Michigan, 49412!.Job Description & Requirements. Registered Nurse – Emergency Room - Travel - (ER R...Show moreLast updated: 4 days ago
    • Promoted
    Travel Nurse RN - PCU - Progressive Care Unit

    Travel Nurse RN - PCU - Progressive Care Unit

    Nationwide Therapy GroupGrand Rapids, MI, US
    Full-time
    Nationwide Therapy Group is seeking a travel nurse RN PCU - Progressive Care Unit for a travel nursing job in Grand Rapids, Michigan. Job Description & Requirements.NTG is committed to matching ...Show moreLast updated: 30+ days ago
    • Promoted
    Medical Device Sales – Paid Internship

    Medical Device Sales – Paid Internship

    Medical Sales CollegeMiddleville, Michigan, US
    Internship
    Description Medical Device Sales - Paid Internship Looking for a rewarding and lucrative career in the medical sales industry? Our paid Internship may be the right path for you! Here are just some ...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - Labor and Delivery

    Travel Nurse RN - Labor and Delivery

    LRS Healthcare - Travel NursingFremont, MI, US
    Permanent
    LRS Healthcare - Travel Nursing is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Fremont, Michigan. Job Description & Requirements.LRS Healthcare - Travel Nursing Job ...Show moreLast updated: 2 days ago
    • Promoted
    Travel Nurse RN - Labor and Delivery

    Travel Nurse RN - Labor and Delivery

    Premier Medical Staffing ServicesFremont, MI, US
    Permanent
    Premier Medical Staffing Services is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Fremont, Michigan. Job Description & Requirements.Job Title : RN, Labor and Deli...Show moreLast updated: 4 days ago