RN Care Manager Complex Pediatric Care REMOTE based in NewYork

JOB

DESCRIPTION

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.

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.

as required.

to evaluate effectiveness, document interventions and goal

achievement, and suggest changes accordingly.

ongoing member caseload for regular outreach and

management.

members including behavioral health, long-term services and

supports (LTSS), and home and community resources to enhance

continuity of care.

team (ICT) meetings and informal ICT collaboration.

Uses motivational interviewing and Molina clinical guideposts to

educate, support and motivate change during member

contacts.

coordination and assistance to member to address

concerns.

recommendations to peers as needed.

may be assigned complex member cases and medication

regimens.

reconciliation as needed.

may be required (based upon state / contractual

requirements).

Required

Qualifications

experience in health care, preferably in care management, or

experience in a medical and / or behavioral health setting, or

equivalent combination of relevant education and

experience.

active and unrestricted in state of practice.

unrestricted driver's license, reliable transportation, and

adequate auto insurance for job related travel requirements, unless

otherwise required by law.

electronic medical record (EMR) and Health Insurance Portability

and Accountability Act (HIPAA).

of community resources.

and demonstrate detail-oriented work.

within a variety of settings and adjust style as needed - working

with diverse populations, various personalities and personal

situations.

supervision and self-motivation.

forms of communication, and ability to remain calm in high-pressure

situations.

professional relationships.

and prioritization skills, and ability to focus on multiple

projects simultaneously and adapt to change.

problem-solving, and critical-thinking skills.

verbal and written communication skills.

Office suite / applicable software program proficiency, and ability

to navigate online portals and

databases.

Preferred

Qualifications

Manager (CCM).

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

from posting based on geographic location, work experience,

education and / or skill level.