Molina Healthcare

Runs health plans for government programs

Pediatrics Care Manager RN

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours

Full-timeOrlando, FL, USA$26.41 - $51.49 /hr

About the Job

Requirements

At least 2 years of experience in health care, preferably in care management, a medical or behavioral health setting, or an equivalent combination of relevant education and experience.
Registered Nurse (RN) with an active and unrestricted license in the state of practice.
Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job-related travel, unless otherwise required by law.
Understanding of electronic medical records (EMR) and the Health Insurance Portability and Accountability Act (HIPAA).
Demonstrated knowledge of community resources.
Ability to operate proactively and perform detail-oriented work.
Ability to work in varied settings and adjust approach when working with diverse populations, personalities, and personal situations.
Ability to work independently with minimal supervision.
Ability to communicate responsively and remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Time-management and prioritization skills, including the ability to focus on multiple projects simultaneously and adapt to change.
Problem-solving and critical-thinking skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office or applicable software programs and ability to navigate online portals and databases.

Responsibilities

Complete comprehensive member assessments within regulated timelines and use clinical judgment, changes in health or psychosocial wellness, and assessment triggers to determine potential eligibility for care management.
Develop and implement care coordination plans with members, caregivers, physicians, other appropriate health care professionals, and member support networks to address needs and goals.
Conduct telephonic, face-to-face, or home visits as required.
Monitor care plans on an ongoing basis, evaluate effectiveness, document interventions and goal achievement, and suggest changes as appropriate.
Maintain an ongoing member caseload for regular outreach and management.
Promote integration of behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
Facilitate interdisciplinary care team (ICT) meetings and informal ICT collaboration.
Use motivational interviewing and Molina clinical guideposts to educate, support, and motivate change during member contacts.
Assess barriers to care and provide care coordination and assistance to address member concerns.
Provide consultation, resources, and recommendations to peers as needed.
Manage complex member cases and medication regimens when assigned to care manager RNs.
Conduct medication reconciliation as needed.
Travel locally as required; estimated travel may be 25–40% based on state and contractual requirements.

Desired Qualifications

Certified Case Manager (CCM).

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.
• 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).

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

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

Salary Range: $26.41 - $51.49 Hourly *Actual compensation may vary based on geographic location, work experience, education and/or skill level

About the Company

Molina Healthcare

Runs health plans for government programs

Molina Healthcare runs health insurance plans for people covered by Medicaid, Medicare and state insurance marketplaces, with a focus on people who need affordable access to care. Its local health plans coordinate medical services and support members with complex health needs, including people eligible for both Medicaid and Medicare. Members receive care through networks of doctors, hospitals and other providers, while the plans manage benefits, process claims and arrange care support. The company earns premiums from government programs and members, and pays the cost of covered healthcare services. Molina was founded in 1980 and is headquartered in Long Beach, California.

Company size: 10,001+
Company stage: IPO
Headquarters: Long Beach, CA
Founded: 1980

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