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 Washington State Medicare plan. We are seeking a Registered Nurse with previous Case Management experience. Medicare knowledge/experience is highly preferred. Proficient knowledge of MS Suite is very helpful. The Case Manager must be able to work in a high-volume environment. Further details to be discussed during our interview process.
Remote position with field travel in Yakima, Benton or Franklin County WA
Work schedule Monday through Friday 8:30 AM to 5:00 PM PST.
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
1-3 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.
Preferred Education
Bachelor's Degree in Nursing
Preferred Experience
3-5 years in case management, disease management, managed care or medical or behavioral health settings.
Preferred License, Certification, Association
Active, unrestricted Certified Case Manager (CCM)
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.
United States
