(RN) Remote Care Manager - CA License req

at Molina Healthcare in Boise, Idaho, United States

JOB DESCRIPTION

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.

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 drivers 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 kno