Case Manager

4 weeks ago


Milwaukee, Wisconsin, United States Molina Healthcare Full time
Job Summary
Molina Healthcare Services (HCS) works with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. Our team ensures that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Key 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.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions, and goal achievement, and suggests 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.
• Assesses for barriers to care, provides care coordination, and assistance to member to address concerns.

Requirements
• RNs are assigned cases with members who have complex medical conditions and medication regimens.
• Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.
• 1-3 years in case management, disease management, managed care, or medical or behavioral health settings.
• Active, unrestricted State Registered Nursing (RN) license in good standing.
• Bachelor's Degree in Nursing
• 3-5 years in case management, disease management, managed care, or medical or behavioral health settings.

About Molina Healthcare
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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