Case Manager, Transplant (RN): CALIFORNIA

Job Description

Job Summary

Transplant Case Managers works with members, providers, Transplant Programs, and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including transitions of care and outpatient care management for members pursuing a transplant.

Transplant Case Manager works 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

• Conducts inpatient reviews for the members on the transplant journey to determine financial responsibility of Molina Healthcare and its members.
• Processes requests within required timelines.
• Assess inpatient services for members to ensure optimum outcomes, costs effectiveness and compliance with all state and federal regulations and guidelines.
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and / or procedures.
• Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.
• Collaborates with multidisciplinary teams to promote Molina Care Model.
• Follows transplant members through a 30-day Transitions of Care intervention that starts at hospital admission and continues through transitions from the acute setting to other settings, including nursing facility placement and private home, with the goal of reduced readmissions.
• Ensures safe and appropriate transitions by collaborating with hospital discharge planners, as well as with hospitalists, outpatient providers, facility staff, and family / support network, as needed or at the request of member.
• Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required.
• Works with participating ancillary providers, public agencies or other service providers to make sure necessary services and equipment are in place for a safe transition.
• Coordinates care and reassesses member's needs post-discharge timeline.
• Educates and supports member focusing on seven primary areas (TC Pillars) : medication management, use of personal health record, follow up care, signs and symptoms of worsening condition, nutrition, functional needs and or Home and Community-based Services, and advance directives.
• Completes clinical 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 from 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.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Promotes integration of services for members including behavioral health care, SDOH, and long-term services and supports 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.
• Maintains ongoing member case load for regular outreach and management.
• Adheres to Health Care services policies and procedures.
• Occasional travel to other Molina Offices, Community, Members homes or hospitals as requested, may be required. This can vary based on the Individual State Plan.

Job Qualifications

REQUIRED EDUCATION :

Graduate from an Accredited School of Nursing.

REQUIRED EXPERIENCE :

3+ years hospital acute care / medical experience.

1-3 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 a 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 :

Recent hospital experience in ICU, Medical, or ER unit.

1-3 years hospital discharge planning or home health.

3-5 years in case management, disease management, managed care or medical or behavioral health

settings.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :

Active, unrestricted Utilization Management Certification (CPHM).

3-5 years hospital discharge planning or home health.

PHYSICAL DEMANDS :

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and / or hazardous working conditions.

Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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 : $23.76 - $51.49 / HOURLY

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

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance.

If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission.

Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

Job Type : Full Time Posting Date : 06 / 25 / 2024