- Conduct thorough assessments of members within specified timelines to identify individuals eligible for case management based on clinical assessment, health changes, and identified triggers.
- Collaborate with the member, caregiver, physician, and healthcare professionals to develop and execute a customized case management plan addressing member needs and goals.
- Conduct face-to-face or home visits as needed.
- Monitor care plan effectiveness, document interventions and goal achievements, and recommend adjustments as necessary.
- Maintain an active member caseload for consistent outreach and management.
- Enhance service integration for members, including behavioral health and long-term care, to improve care continuity for Molina members.
- Facilitate interdisciplinary care team meetings and informal collaboration.
- Utilize motivational interviewing and Molina clinical guidelines to educate, support, and drive change during member interactions.
- Identify and address care barriers, provide coordination and assistance to members.
- Local travel may be required within a range of 25-40%.
- Provide consultation, recommendations, and education to non-RN case managers.
- Handle cases of members with complex medical conditions and medication regimens.
- Conduct medication reconciliation when necessary.
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Case Manager - Glen Allen, United States - Molina Healthcare
Description
Job Description
JOB DESCRIPTION
For this role, we are looking for a Registered Nurse residing in VIRGINIA and holding a valid RN license for the state. Ideal candidates will be located in the Western region of Virginia.
The Case Manager RN will be responsible for working in both remote and field settings, providing support to our Foster Care Medicaid Population. Strong computer skills and attention to detail are crucial to juggle various systems, communicate with members over the phone, and input accurate contact notes. This role is fast-paced, emphasizing on productivity.
(Up to 25%) TRAVEL: Field visits to meet with members in nearby areas will be necessary within a 2-hour travel radius. Mileage expenses will be covered. Travel will be limited to a 2-hour radius.
Locations (Various within VA): Northern, Central, and Hampton Roads VA
Schedule: Monday - Friday 8 AM to 5 PM EST (On Call one week per year, No Holidays or Weekends)
Job Summary
Molina Healthcare Services (HCS) collaborates with members, providers, and multidisciplinary teams to evaluate, facilitate, plan, and coordinate the delivery of care across different levels, encompassing behavioral health and long-term care, for high-need members. The HCS team strives to ensure that patients progress towards desired outcomes through quality, cost-effective care tailored to the severity of illness and service location.
SKILLS AND ABILITIES
JOB REQUIREMENTS
Education
Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.
Experience
1-3 years in case management, disease management, managed care, or medical/behavioral health settings.
License/Certification
Active, unrestricted State Registered Nursing (RN) license in good standing. Valid driver's license with a clean record and reliable transportation.
Preferred Qualifications
Education
Bachelor's Degree in Nursing
Experience
3-5 years in case management, disease management, managed care, or medical/behavioral health settings.
License/Certification
Active, unrestricted Certified Case Manager (CCM)
If you are a current Molina employee interested in this position, please apply via the intranet job listing.
Molina Healthcare provides competitive benefits and compensation. We are proud to be an Equal Opportunity Employer (EOE) M/F/D/V.
