Care Manager (San Juan, McKinley County based)- LPN/RN

Job Summary

Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. 

This role works in the San Juan or McKinley Counties. 

Essential Job Duties
• Completes assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments. 
• Develops and implements care plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. 
• Conducts telephonic, face-to-face or home visits as required. 
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. 
• Maintains ongoing member caseload for regular outreach and management. 
• Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. 
• Facilitates interdisciplinary care team (ICT) 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. 
• Collaborates with licensed care managers/leadership as needed or required. 
• 25- 40% estimated local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.

• Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates.

• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.

• Demonstrated knowledge of community resources.

• Ability to operate proactively and demonstrate detail-oriented work.

• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations

.• Ability to work independently, with minimal supervision and self-motivation.

• Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations.

• Ability to develop and maintain professional relationships.

• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.

• Excellent problem-solving and critical-thinking skills.

• Strong verbal and written communication skills.

• Microsoft Office suite/applicable software program(s) proficiency.

• In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).

Preferred Experience: 

LPN (Licensed Practical Nurse). 

Experience with Medicare Advantage, D-SNP, integrated care management. 

Experience working with New Mexico Medicaid/Medicare MCO

Pay Range: $24 - $46.81 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.