Case Manager RN (Maternity, Pediatric, and Adult Medicaid)

Internal Number : 2026571

JOB DESCRIPTION

For this position we are seeking a RN who lives in VIRGINIA and must be licensed for the state of VIRGINIA. We are looking for candidates who live in the Western region of Virginia.

Case Manager RN will work in remote and field setting supporting our Maternity Medicaid Population (This role will support Pediatrics, Maternity and Adult Medicaid Population.

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 fast-paced position and productivity is important.

Up to 25%) TRAVEL in the field to do member visits in the surrounding areas will be required within 2-hour travel radius - Mileage will be reimbursed.

Travel will be within a 2-hour radius.

Locations (Various within VA) : Charlottesvilles, Central, and Hampton Roads VA

Monday - Friday 8 AM to 5 PM EST (On Call one week per year) - No Holidays or Weekends

Job Summary

Molina Healthcare Services (HCS) works 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.

HCS staff work to ensure 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.

KNOWLEDGE / SKILLS / ABILITIES

• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment.
• Develops and implements a case management plan in collaboration with the member, caregiver, physician and / or other appropriate healthcare professionals and member's support network to address the member needs and goals.
• Conducts face-to-face or home visits as required.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member case load for regular outreach and management.
• Promotes integration of services for members including behavioral health care and long term services and supports / home and community to enhance the continuity of care for Molina members.
• Facilitates interdisciplinary care team 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.
• 25- 40% local travel required.
• RNs provide consultation, recommendations and education as appropriate to non-RN case managers.
• RNs are assigned cases with members who have complex medical conditions and medication regimens
• RNs conduct medication reconciliation when needed.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

years in case management, disease management, managed care or medical or behavioral health settings.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

years in case management, disease management, managed care or medical or behavioral health settings.

Preferred License, Certification, Association

Active, unrestricted Certified Case Manager (CCM)

To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing.

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

Pay Range : $ - $ / HOURLY

• Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
30+ days ago