Care Manager (RN) - King County/Peds

Hybrid role with approximately 10% local travel within King County.

About the role

Provides support for care management and care coordination activities, collaborating with a multidisciplinary team to coordinate integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to the overarching strategy to provide quality and cost-effective care.

Responsibilities

• Completes comprehensive assessments of members per regulated timelines and determines eligibility for care management based on clinical judgment, changes in health or psychosocial wellness, and assessment triggers.
• Develops and implements a care coordination plan in collaboration with the member, caregiver, physician, and other healthcare professionals to address member needs and goals.
• Conducts telephonic, 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 an ongoing caseload of 30-35 members 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 barriers to care, provides care coordination, and assists members in addressing concerns.
• May provide consultation, resources, and recommendations to peers as needed.
• For RNs: may be assigned complex member cases and medication regimens, and conduct medication reconciliation as needed.
• 25-40% estimated local travel may be required based on state or contractual requirements.

Requirements

• At least 2 years of experience in healthcare, preferably in care management, or in a medical and/or behavioral health setting, or 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 Health Insurance Portability and Accountability Act (HIPAA).
• Demonstrated knowledge of community resources.
• Ability to work proactively, demonstrate detail-oriented work, and adjust style as needed for diverse populations and situations.
• Ability to work independently with minimal supervision and self-motivation.
• Strong responsiveness in communication and ability to remain calm in high-pressure situations.
• Excellent time-management, prioritization, and multitasking skills with the ability to adapt to change.
• Strong problem-solving, critical-thinking, verbal, and written communication skills.
• Proficiency in Microsoft Office suite and ability to navigate online portals and databases.

Preferred Qualifications

• Certified Case Manager (CCM).
• Care management experience in Pediatrics, NICU, or Private Duty Nursing.
• Prior experience working remotely in a care management or clinical setting.

Pay

$26.41 - $59.21 per hour. Actual compensation may vary based on geographic location, work experience, education, and skill level.