Job Description ENROLLMENT (RN) CASE MANAGER
DAY IN THE LIFE:
The team is comprised of Registered Nurses, who will make outreach calls to members to enroll them into care management services at Molina. You will be the first touch to the Molina Family, and your role is to build a relationship while educating the member on the care management services and benefits, The goal is to help them understand and navigate their healthcare needs and community resources available to them. You must be clinically knowledgeable to telephonically assess the member's healthcare and community needs. You will collaborate with the team, physicians and member while building a care plan to meet the member's needs. You will also document on multiple disease processes. The Case Manager will use their assessment to identify and effectively manage the immediate and long term needs of the member. You will have the joy of connecting to that member and letting them understand that we care about them and their health. The team is very positive and life edifying. Bring your positive attitude and strong clinical skills to change the healthcare of many Ohioans.
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.
• 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.
• 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.
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.
Required License, Certification, Association
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.
Bachelor's Degree in Nursing
3-5 years in case management, disease management, managed care or medical or behavioral health settings.
Preferred License, Certification, Association
Certified Case Manager (CCM)
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
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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