About the position
Molina Healthcare Services (HCS) is dedicated to working with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum. This includes behavioral health and long-term care for members with high need potential. The HCS staff play a crucial role in ensuring that patients progress toward desired outcomes through quality care that is both medically appropriate and cost-effective, taking into account the severity of illness and the site of service. In this role, the case manager will complete comprehensive assessments of members within regulated timelines, determining eligibility for case management based on clinical judgment, changes in the member's health or psychosocial wellness, and triggers identified during assessments. The case manager will develop and implement a case management plan in collaboration with the member, caregiver, physician, and other healthcare professionals, as well as the member's support network, to address their needs and goals. This position requires conducting face-to-face or home visits as necessary and performing ongoing monitoring of the care plan to evaluate its effectiveness, document interventions, and suggest changes as needed. The case manager will maintain an ongoing member caseload for regular outreach and management, promoting the integration of services for members, including behavioral health care and long-term services and supports, to enhance continuity of care. Facilitating interdisciplinary care team meetings and informal collaboration is essential, as is using motivational interviewing and Molina clinical guideposts to educate, support, and motivate change during member contacts. The case manager will assess barriers to care and provide coordination and assistance to members to address their concerns. This position requires 25-40% local travel, and RNs will provide consultation, recommendations, and education as appropriate to non-RN case managers, particularly for cases involving members with complex medical conditions and medication regimens. Medication reconciliation will also be conducted when necessary.
Responsibilities
- Complete comprehensive assessments of members per regulated timelines.
- Determine eligibility for case management based on clinical judgment and changes in member's health or psychosocial wellness.
- Develop and implement a case management plan in collaboration with the member, caregiver, physician, and other healthcare professionals.
- Conduct face-to-face or home visits as required.
- Perform ongoing monitoring of the care plan to evaluate effectiveness and document interventions.
- Maintain an ongoing member caseload for regular outreach and management.
- Promote integration of services for members, including behavioral health care and long-term services and supports.
- Facilitate interdisciplinary care team meetings and informal collaboration.
- Use motivational interviewing and Molina clinical guideposts to educate and support members.
- Assess barriers to care and provide care coordination and assistance to members.
Requirements
- Graduate from an Accredited School of Nursing.
- Active, unrestricted State Registered Nursing (RN) license in good standing.
- 1-3 years in case management, disease management, managed care, or medical or behavioral health settings.
- Must have a valid driver's license with a good driving record and reliable transportation.
Nice-to-haves
- Bachelor's Degree in Nursing (preferred).
- 3-5 years in case management, disease management, managed care, or medical or behavioral health settings (preferred).
- Active, unrestricted Certified Case Manager (CCM) (preferred).
Benefits
- Competitive benefits and compensation package.
