Case Manager
1 month ago
Molina Healthcare Services (HCS) collaborates with members, providers, and multidisciplinary teams 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.
Key Responsibilities- Conduct comprehensive assessments of members within regulated timelines and determine who may qualify for case management based on clinical judgment, changes in member health or psychosocial wellness, and triggers identified in the assessment.
- Develop and implement a case management plan in collaboration with the member, caregiver, physician, and/or other appropriate healthcare professionals and member's support network to address member needs and goals.
- Perform ongoing monitoring of the care plan to evaluate effectiveness, document interventions, and suggest changes accordingly.
- Maintain ongoing member case load for regular outreach and management.
- 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.
- Facilitate interdisciplinary care team meetings 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 concerns.
- 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 a valid driver's license with a good driving record and be able to drive within applicable state or locality with reliable transportation.
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