Case Manager RN
2 days ago
Molina Healthcare is seeking a skilled Case Manager RN to join our team. As a Case Manager RN, you will play a critical role in supporting our Medicaid Medicare Population with members on Waiver programs.
Job SummaryThe Case Manager RN will have a caseload and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with managed care populations and/or case management roles.
Key Responsibilities- Conduct face-to-face comprehensive assessments of members per regulated timelines.
- Facilitate comprehensive waiver enrollment and disenrollment processes.
- Develop and implement a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician, and/or other appropriate healthcare professionals and member's support network.
- Perform ongoing monitoring of the care plan to evaluate effectiveness, document interventions, and goal achievement, and suggest changes accordingly.
- Promote 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.
- Assess for medical necessity and authorize all appropriate waiver services.
- Evaluate covered benefits and advise appropriately regarding funding source.
- Conduct face-to-face or home visits as required.
- Facilitate interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration.
- Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate change during member contacts.
- Assess for barriers to care, provide care coordination, and assistance to members to address psycho/social, financial, and medical obstacles concerns.
- Identify critical incidents and develop prevention plans to assure member's health and welfare.
- Provide consultation, recommendations, and education as appropriate to non-RN case managers.
- Graduate from an Accredited School of Nursing.
- At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports.
- 1-3 years in case management, disease management, managed care, or medical or behavioral health settings.
- Active, unrestricted State Registered Nursing license (RN) in good standing.
- If field work is required, must have a valid driver's license with a good driving record and be able to drive within applicable state or locality with reliable transportation.
- Bachelor's Degree in Nursing.
- 3-5 years in case management, disease management, managed care, or medical or behavioral health settings.
- 1 year experience working with a population who receive waiver services.
- Active and unrestricted Certified Case Manager (CCM).
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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