Care Manager (RN) - WA

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 member care.

Qualified candidates must reside in Washington State, have an unrestricted nursing license, and be able to travel up to 20% as needed. The ideal candidate will have prior telephonic case management experience and demonstrate strong technical proficiency, including the ability to efficiently navigate multiple systems and platforms simultaneously.

Responsibilities

• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness, and triggers identified in assessments.
• Develops and implements a care coordination plan in collaboration with the member, caregiver, physician, and/or other appropriate health care professionals and member support network 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 member caseload 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 the member in addressing concerns.
• May provide consultation, resources, and recommendations to peers as needed.
• May be assigned complex member cases and medication regimens; may conduct medication reconciliation as needed.
• 25-40% estimated local travel may be required (based upon state/contractual requirements).

Requirements

• At least 2 years of experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or an 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 requirements, unless otherwise required by law.
• Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA).
• Demonstrated knowledge of community resources.
• Ability to operate proactively and demonstrate detail-oriented work.
• Ability to work within a variety of settings and adjust style as needed—working with diverse populations, various personalities, and personal situations.
• Ability to work independently, with minimal supervision, and self-motivation.
• Responsiveness in all forms of communication and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills, with the ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving and critical-thinking skills.
• Strong verbal and written communication skills.
• Proficiency in Microsoft Office suite/applicable software programs and ability to navigate online portals and databases.

Preferred Qualifications

• Certified Case Manager (CCM).
• Experience in critical care, skilled nursing facility (SNF), and utilization management (UM) settings.
• Advanced organizational and multitasking skills, highly adaptable in a technology-driven environment, and strong Microsoft Excel capabilities.

Pay

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