RN Care Coordinator, Home Healthcare

Job Summary:

We are seeking a Registered Nurse (RN) who must reside in the state of Michigan and have a current active unrestricted RN license. This position will support our Medicaid Medicare Population team.

The ideal candidate has experience working with managed care populations and/or case management roles. They should possess excellent computer skills, be diligent, and able to multitask between systems, communicate effectively with members on the phone, and enter accurate contact notes.

This role requires field work, conducting face-to-face assessments with members in their homes. Travel is required to visit members in surrounding areas, including Detroit and Gross Pointe in Wayne County, up to 50% of the time. Mileage is reimbursed.

The schedule is Monday through Friday, 8:30 AM to 5:00 PM EST, with no weekends or holidays.

Molina Healthcare Services works with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate integrated care delivery across the continuum, including behavioral health and long-term care for high-need members.

The HCS staff ensures patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on severity of illness and site of service.

Responsibilities:

• Develops and implements a case management plan in collaboration with the member, caregiver, physician, and other healthcare professionals to address member needs and goals.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions, and goal achievement, and suggests changes accordingly.
• Promotes integration of services for members, including behavioral health care and long-term services and supports, home and community care to enhance continuity of care for Molina members.
• Assesses medical necessity and authorizes waiver services.
• Facilitates interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate, support, and motivate change during member contacts.
• Assesses barriers to care, provides care coordination, and assistance to members to address psycho-social, financial, and medical obstacles concerns.
• Identifies critical incidents and develops prevention plans to assure member's health and welfare.
• Provides consultation, recommendations, and education as appropriate to non-RN case managers.
• Works cases with members who have complex medical conditions and medication regimens.

Requirements:

• Graduate from an accredited school of nursing.
• At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports.
• 1-3 years of experience in case management, disease management, managed care, or medical or behavioral health settings.
• Active, unrestricted State Registered Nursing license (RN) in good standing.
• If field work is required, must have a valid driver's license with a good driving record and reliable transportation.

Preferred Qualifications:

• Bachelor's Degree in Nursing.
• 3-5 years of experience in case management, disease management, managed care, or medical or behavioral health settings.
• 1 year of experience working with a population receiving waiver services.
• Active and unrestricted Certified Case Manager (CCM).

About Us:

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