Case Manager (RN): California, Riverside County, San Bernardino County

$49,421 - $107,099/Yr

Molina Healthcare - Ontario, CA

Full-time

Ontario, CA

Insurance Carriers and Related Activities

About the position

The Case Manager (RN) position at Molina Healthcare involves working with members, providers, and multidisciplinary teams to assess, plan, and coordinate integrated care for members with high needs. The role focuses on ensuring quality, medically appropriate, and cost-effective care across various settings, including behavioral health and long-term care. The Case Manager will conduct assessments, develop care plans, and facilitate communication among healthcare professionals to enhance member outcomes.

Responsibilities

• Complete comprehensive assessments of members per regulated timelines to determine eligibility for case management.
• Develop and implement a case management plan in collaboration with members, caregivers, and healthcare professionals.
• Conduct face-to-face or home visits as required.
• Perform ongoing monitoring of care plans to evaluate effectiveness and suggest changes as needed.
• Maintain an ongoing member case load for regular outreach and management.
• Promote integration of services for members, including behavioral health care and long-term services.
• Facilitate interdisciplinary care team meetings and informal collaborations.
• Use motivational interviewing to educate and support members during contacts.
• Assess for barriers to care and provide coordination and assistance to members.
• Conduct medication reconciliation when needed.

Requirements

• Graduate from an Accredited School of Nursing.
• Active, unrestricted State Registered Nursing (RN) license in good standing.
• 1-3 years of experience in case management, disease management, managed care, or medical/behavioral health settings.
• Valid driver's license with a good driving record.

Nice-to-haves

• Bachelor's Degree in Nursing (preferred).
• 3-5 years of experience in case management, disease management, managed care, or medical/behavioral health settings (preferred).
• Active, unrestricted Certified Case Manager (CCM) certification (preferred).

Benefits

• Competitive benefits and compensation package.