Healthcare - Case Manager II

Health Care Management Coordinator

Reason for openings: Assist with closing Quality HEDIS gaps and other STARs measures. Will these roles be fully remote? Yes. Are there any specific locations the candidates should be in? Would prefer candidate not reside in EST due to the time difference. Expected schedule: M-F 8-5pm PST. Day to day job duties include member outreach to educate on gaps of care and health conditions, care planning and assessment completions, care coordination with providers and coordination of benefits.

Top skills required: Ability to assess and educate on complex health conditions, create complex care plans based on all health conditions, coordinate care with providers and other community partners. Experience with insurance case management preferred. Required education/certification: RN licensure. Required years of experience: 3-5 years.

Required IT equipment: Laptop, dual monitors, mouse, keyboard and docking station.

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, 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), skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.

Required education: 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: 2-4 years of clinical experience with case management experience. Required licensure/certification: 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.