CASE MANAGER REGISTERED NURSE for our CALIFORNIA Health Plan. Candidates must live in the state of California in Sacramento County, LA COUNTY, San Diego County, San Bernardino or Riverside COUNTY. Bilingual Spanish preferred.We are looking for an RN with at least 1 year of relevant Case Management experience. Ambulatory Case Management, OB GYN Case Management or Disease Management preferred.Case Manager RN will work in remote and field settings our Medicaid Population assisting with transition from inpatient admission to next steps. This role will allow you to work as a case manager to ensure our members have a successful discharge from the hospital to home. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Excellent skillset working with EMR's and Microsoft Office.Travel may be required in the future to do member visits in the surrounding areas. Travel will be within a 1- 2-hour radius in the county that you live in. A clean DMV driving record, proof of auto insurance, and reliable transportation is required. Must be able to do your own driving. Please consider this requirement before you apply to this role. We do provide Mileage reimbursement.Home office with internet connectivity of high speed required. You must provide your own home office including desk and chair.Work Schedule: Monday thru Friday 8:30AM to 5:30PM Pacific.JOB DESCRIPTIONJob SummaryMolina 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
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 QUALIFICATIONSRequired EducationGraduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.Required Experience1-3 years in case management, disease management, managed care or medical or behavioral health settings.Required License, Certification, AssociationActive, 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 EducationBachelor's Degree in NursingPreferred Experience3-5 years in case management, disease management, managed care or medical or behavioral health settings.Preferred License, Certification, AssociationActive, 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.Pay Range: $23.76 - $51.49 / HOURLYActual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
