Healthcare - Case Manager III

RN Case Manager

This position is for an RN Case Manager in San Diego County, California. The role will be remote, but there may be times the case manager may need to work in the office or make visits to see members in-person. It's very minimal at this time, but could happen. The expected schedule is Monday through Friday, 8:30AM to 5:30PM PST. The day to day job duties include outreach to members assigned to them, completing various assessments, creating individualized care plans, and assisting members with community resources/linkages.

Top skills required include strong computer skills, organization, and health literacy. The required education is an RN, and the preferred years of experience is three, but someone with less years may be considered depending on their work experience. Extra equipment required includes dual monitors and a docking station. There is potential for this role to extend past three months or convert to a full-time equivalent.

Summary: Responsible for health care management and coordination of Molina Healthcare members in order to achieve optimal clinical, financial, and quality of life outcomes. Works with members to create and implement an integrated collaborative plan of care. Coordinates and monitors Molina member's progress and services to ensure consistent cost effective care that complies with Molina policy and all state and federal regulations and guidelines.

Essential functions include providing case management services to members with chronic or complex conditions, promoting integration of services for members including behavioral health and long term care, conducting face to face or home visits as required, maintaining department productivity and quality measures, managing and completing assigned work plan objectives and projects in a timely manner, demonstrating dependability and reliability, maintaining effective team member relations, adhering to all documentation guidelines, attending regular staff meetings, participating in Interdisciplinary Care Team (ICT) meetings, assisting orientation and mentoring of new team members as appropriate, maintaining professional relationships with provider community and internal and external customers, conducting self in a professional manner at all times, maintaining cooperative and effective workplace relationships and adhering to company Code of Conduct, participating in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth, and complying with required workplace safety standards.

Knowledge/skills/abilities include demonstrated ability to communicate, problem solve, and work effectively with people, excellent organizational skill with the ability to manage multiple priorities, work independently and handle multiple projects simultaneously, strong analytical skills, knowledge of applicable state, and federal regulations, knowledge of ICD-9, CPT coding and HCPC, SSI, Coordination of benefits, and Third Party Liability programs and integration, familiarity with NCQA standards, state/federal regulations and measurement techniques, in depth knowledge of CCA and/or other Case Management tools, ability to take initiative and see tasks to completion, computer skills and experience with Microsoft Office Products, excellent verbal and written communication skills, ability to abide by Molina's policies, able to maintain regular attendance based upon agreed schedule, maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA), and skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.

Required education is a Bachelor's degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree). Required experience is 5-7 years of clinical experience with case management experience. Required licensure/certification is an active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing. A combination of experience and education will be considered in lieu of LCSW or APSW. Must have valid driver's license with good driving record and be able to drive locally.