Case Manager (RN)

$49,421 - $107,099/Yr

Molina Healthcare - Richmond, KY

Full-time

Remote - Richmond, KY

Insurance Carriers and Related Activities

About the position

The Case Manager (RN) at Molina Healthcare is responsible for assessing, planning, and coordinating integrated care for members with high need potential. This role involves working closely with members, providers, and multidisciplinary teams to ensure quality care that is medically appropriate and cost-effective. The position requires conducting comprehensive assessments, developing care plans, and facilitating interdisciplinary collaboration to enhance continuity of care.

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 the member, caregiver, physician, and support network.
• Conduct face-to-face or home visits as required.
• Perform ongoing monitoring of the care plan 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 collaboration.
• 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.