Healthcare Case Manager
1 week ago
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.
HCS staff work to ensure 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.
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 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.
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.
25-40% local travel required.
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.
Qualifications
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.
Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
Preferred Qualifications
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).
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