Care Manager (RN) Remote (Dona Ana, NM)

Act as a Care Manager RN supporting our NM Medicaid members to ensure management of health conditions. This hybrid remote field RN position involves a combination of phone outreach and in-person meetings with members.

Responsibilities

• Complete comprehensive assessments of members per regulated timelines and determine eligibility for care management based on clinical judgment, health changes, or psychosocial wellness.
• Develop and implement care coordination plans in collaboration with members, caregivers, physicians, and other healthcare professionals to address member needs and goals.
• Conduct telephonic, face-to-face, or home visits as required.
• Perform ongoing monitoring of care plans to evaluate effectiveness, document interventions, and suggest changes.
• Maintain an ongoing member caseload for regular outreach and management.
• Promote integration of services, including 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, provide care coordination, and assist members in addressing concerns.
• Provide consultation, resources, and recommendations to peers as needed.
• Handle complex member cases and medication regimens, including conducting medication reconciliation as needed.
• Perform local travel (25-40% estimated) 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.
• Active and unrestricted Registered Nurse (RN) license in the 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 electronic medical records (EMR) and Health Insurance Portability and Accountability Act (HIPAA).
• Demonstrated knowledge of community resources.
• Ability to work proactively, independently, and with minimal supervision.
• Strong verbal and written communication skills, with the ability to remain calm in high-pressure situations.
• Excellent time-management, prioritization, and problem-solving skills.
• Proficiency in Microsoft Office suite and ability to navigate online portals and databases.

Preferred Qualifications

• Certified Case Manager (CCM).
• Previous case management or managed care experience.

Schedule

• Monday through Friday, 8 AM to 5 PM Mountain Time (no weekends, nights, or holidays).
• Alternative work schedules available after 6 months: four 10-hour shifts or four 9-hour shifts with a half-day shift.

Benefits

• Mileage reimbursement as part of the benefit package.

Pay

Pay Range: $26.41 - $51.49 per hour. Actual compensation may vary based on geographic location, work experience, education, and skill level.