Telephonic Case Manager (RN) - Illinois ONLY

About the position

Opportunity to join Molina Healthcare working with our Medicaid members as a Case Manager. This is open to Illinois licensed RNs across the state who have experience working with patients with respiratory diagnosis like asthma, pulmonary hypertension, or COPD. This is a fully remote opportunity conducting assessments by phone to determine the resources we need to provide as well as case management for the member. Our ideal applicant would be someone who has experience doing case management/discharge planning in a managed care organization (MCO) like Molina and has been a RN for at least 5 years. Hours are Monday - Friday, 8AM - 5PM CST. Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, Teams, and One Note as well as experience using a clinical documentation software program.

Responsibilities

• 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.
• 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.

Requirements

• Graduate from an Accredited School of Nursing.
• Active, 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.
• 1-3 years in case management, disease management, managed care or medical or behavioral health settings.

Nice-to-haves

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

Benefits

• Competitive benefits and compensation package.