Telephonic Case Manager (RN) PACIFIC HOURS 8AM to 5PM at Molina Healthcare

About the position

Molina Healthcare Services (HCS) is seeking a Telephonic RN to join our Marketplace Team, focusing on telephonic Case Management. This position is 100% remote, with a schedule from Monday to Friday, 8 AM to 5 PM PST. Flexibility in scheduling is essential, as the role may require working a couple of evenings each week to better reach our members. Candidates should consider this requirement before applying. Experience with OB/High Risk Pregnancy cases is crucial for success in this role, and being bilingual in Spanish is a plus. We are open to considering candidates residing in California, Idaho, Washington, Utah, and Nevada. In this role, the Telephonic RN will work closely with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care for members with high need potential. The HCS staff is dedicated to ensuring that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. The Telephonic RN will complete comprehensive assessments of members within regulated timelines and determine eligibility for case management based on clinical judgment, changes in the member's health or psychosocial wellness, and triggers identified in the assessment. They will develop and implement a case management plan in collaboration with the member, caregiver, physician, and other healthcare professionals to address the member's needs and goals. Ongoing monitoring of the care plan will be required to evaluate effectiveness, document interventions, and suggest changes as necessary. The RN will maintain an ongoing member caseload for regular outreach and management, promoting the integration of services for members, including behavioral health care and long-term services and supports to enhance continuity of care for Molina members.

Responsibilities
? Complete comprehensive assessments of members per regulated timelines.
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? Determine eligibility for case management based on clinical judgment and health changes.
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? Develop and implement a case management plan in collaboration with the member and healthcare professionals.
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? Conduct face-to-face or home visits as required.
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? Perform ongoing monitoring of the care plan to evaluate effectiveness and document interventions.
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? Maintain an ongoing member caseload for regular outreach and management.
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? Promote integration of services for members, including behavioral health care and long-term services.
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? Facilitate interdisciplinary care team meetings and informal ICT collaboration.
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? Use motivational interviewing to educate and support members during contacts.
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? Assess for barriers to care and provide care coordination and assistance.

Requirements
? Graduate from an Accredited School of Nursing.
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? Active, unrestricted State Registered Nursing (RN) license in good standing.
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? 1-3 years of experience in case management, disease management, managed care, or medical/behavioral health settings.
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? Valid driver's license with a good driving record.

Nice-to-haves
? Bilingual in Spanish is a plus.
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? 3-5 years of experience in case management, disease management, managed care, or medical/behavioral health settings.
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? Active, unrestricted Certified Case Manager (CCM) certification.

Benefits
? Competitive benefits and compensation package.
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? Pay range: $23.76 - $51.49 per hour, based on geographic location, work experience, education, and skill level.

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