About the position
As a Case Manager (RN) specializing in High Risk OB at Molina Healthcare, you will play a crucial role in the integrated delivery of care for members with high need potential. This position requires you to work collaboratively with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate care across various settings, including behavioral health and long-term care. You will be responsible for ensuring that patients progress toward desired health outcomes through quality care that is both medically appropriate and cost-effective, tailored to the severity of illness and the site of service. In this fast-paced role, you will manage a caseload of members, conducting comprehensive assessments to determine eligibility for case management based on clinical judgment and changes in health or psychosocial wellness. You will develop and implement individualized case management plans in collaboration with members, caregivers, and healthcare professionals, ensuring that all aspects of the member's needs and goals are addressed. Regular monitoring of care plans will be essential to evaluate effectiveness, document interventions, and suggest necessary changes. You will also facilitate interdisciplinary care team meetings and promote the integration of services, including behavioral health care and long-term services, to enhance continuity of care for Molina members. Utilizing motivational interviewing techniques, you will educate and support members, helping them overcome barriers to care and motivating them to engage in their health management actively. This position may require local travel for team meetings, audits, and training sessions, and you will need to maintain a home office with high-speed internet connectivity.
Responsibilities
- Assess and facilitate care for members with high need potential.
- Develop and implement case management plans in collaboration with members and healthcare professionals.
- Conduct comprehensive assessments of members to determine eligibility for case management.
- Perform ongoing monitoring of care plans to evaluate effectiveness and document interventions.
- 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.
- Maintain an ongoing caseload for regular outreach and management.
Requirements
- Graduate from an Accredited School of Nursing; Bachelor's Degree in Nursing preferred.
- 1-3 years of experience in case management, disease management, managed care, or medical/behavioral health settings.
- Active, unrestricted State Registered Nursing (RN) license in good standing.
- Valid driver's license with a good driving record.
Nice-to-haves
- 3-5 years of experience in case management, disease management, managed care, or medical/behavioral health settings.
- Active, unrestricted Certified Case Manager (CCM) certification.
Benefits
- Medical, Dental, and Vision Insurance
- Group & Voluntary Life Insurance
- Aflac, Pet Health, and Identity Theft Insurance
- Flexible Spending Accounts
- 401K and Roth 401K
- Employee Stock Purchase Plan
- Continuing Education Units
- Education Reimbursement
- Paid Time Off
- Volunteer Time Off
- Company Holidays
- Legal Assistance Plan
- Employee Assistance & Well Being Programs
- Employee Perks Platform
- Rideshare Portal
