(RN) Remote Care Manager – CA License req

Job Title

Care Manager RN

Job Summary

Provide essential support for care management and care coordination activities, collaborating with a multidisciplinary team to ensure the integrated delivery of member care across the continuum. The goal is to ensure member progress toward desired outcomes and contribute to the overarching strategy of providing quality, cost-effective member care.

Essential Job Duties

• Complete comprehensive member assessments within regulated timelines to identify eligibility for care management based on clinical judgment, health changes, and assessment triggers.
• Develop and implement care coordination plans collaboratively with members, caregivers, physicians, and healthcare professionals to address member needs and goals.
• Conduct telephonic, face-to-face, or home visits as required.
• Perform ongoing monitoring of care plans to evaluate effectiveness, document interventions, track goal achievement, and recommend necessary adjustments.
• Maintain an ongoing caseload for regular member outreach and management.
• Promote the integration of services, including behavioral health, long-term services and supports (LTSS), and home/community resources, to enhance continuity of care.
• Facilitate interdisciplinary care team (ICT) meetings and informal ICT collaboration.
• Utilize motivational interviewing techniques and Molina clinical guideposts to educate, support, and motivate members towards positive change.
• Assess for barriers to care and provide care coordination and assistance to address member concerns.
• May provide consultation, resources, and recommendations to peers.
• Care Manager RNs may be assigned complex member cases and medication regimens.
• Care Manager RNs may conduct medication reconciliation as needed.

Required Qualifications

• Minimum of 2 years of experience in healthcare, preferably in care management, or in a medical and/or behavioral health setting, or an equivalent combination of relevant education and experience.
• Active and unrestricted Registered Nurse (RN) license in the state of practice.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job-related travel, unless otherwise mandated by law.
• Understanding of Electronic Medical Records (EMR) systems and HIPAA regulations.
• Demonstrated knowledge of community resources.
• Ability to work proactively and demonstrate meticulous attention to detail.
• Adaptability to work in various settings and with diverse populations, personalities, and personal situations.
• Ability to work independently with minimal supervision and strong self-motivation.
• Responsiveness in all forms of communication and ability to remain calm in high-pressure situations.
• Skill in developing and maintaining professional relationships.
• Excellent time-management and prioritization skills, with the ability to manage multiple projects simultaneously and adapt to change.
• Strong problem-solving and critical-thinking abilities.
• Proficiency in Microsoft Office Suite and other applicable software programs; ability to navigate online portals and databases.

Preferred Qualifications

• Certified Case Manager (CCM).
• Bilingual capabilities.
• Home Health experience.

About Molina Healthcare

Molina Healthcare offers a competitive benefits and compensation package and is an Equal Opportunity Employer (EOE) committed to diversity (M/F/D/V).