Care Manager (RN) Remote (Detroit, MI)

Job Title

Care Manager RN

Job Description

This RN will act as a Care Manager supporting our Michigan Medicaid members, identified with complex medical needs. The Medicaid Care Manager will support them to ensure a successful health outcomes. The position includes telephonic outreach to members to conduct health assessments, identify needs, and the development of care plans to support members health goals. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes.

This is a telephonic position and productivity is important. Preferred candidates will have previous case management, managed care, or inpatient hospital experience. Experience in a behavioral health setting would be a plus.

TRAVEL in the field to designated hospitals in the local service delivery area to meet with the members. Mileage is reimbursed as part of our benefit package.

Schedule: Monday through Friday 8:30AM to 5:00PM EST (No weekends, no nights, no holidays, no call.) Alternative work schedule is available after 6 month exp and at Manager discretion: 4 10-hour shifts

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.

Essential Job Duties

Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. Develops and implements care coordination 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. May provide consultation, resources and recommendations to peers as needed. Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may conduct medication reconciliation as needed. 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. Registered Nurse (RN). License must be active and unrestricted in state of practice. Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA). 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. Responsiveness in all forms of communication, and ability to 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 proficiency, and ability to navigate online portals and databases.

Preferred Qualifications Certified Case Manager (CCM).

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V