Registered Nurse (RN) – UM Case Manager in in Columbus, Ohio (1990BR) Columbus, Ohio

 

Job Summary

Responsible for health care management and coordination of Molina Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes. Works with members to create and implement an integrated collaborative plan of care. Coordinates and monitors Molina member’s progress and services to ensure consistent cost effective care that complies with Molina policy and all state and federal regulations and guidelines.

Essential Functions

• Provides case management services to members with chronic or complex conditions including:
o Proactively identifies members that may qualify for potential case management services.
o Conducts assessment of member needs by collecting in-depth information from Molina’s information system, the member, member’s family/caregiver, hospital staff, physicians and other providers.
o Identifies, assesses and manages members per established criteria.
o Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
o Performs ongoing monitoring of the plan of care to evaluate effectiveness.
o Documents care plan progress in Molina’s information system.
o Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
o Measures the effectiveness of interventions to determine case management outcomes.
• Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Molina members.
• Conducts face to face or home visits as required.
• Maintains department productivity and quality measures.
• Manages and completes assigned work plan objectives and projects in a timely manner.
• Demonstrates dependability and reliability.
• Maintains effective team member relations.
• Adheres to all documentation guidelines.
• Attends regular staff meetings.
• Participates in Interdisciplinary Care Team (ICT) meetings.
• Assists orientation and mentoring of new team members as appropriate.
• Maintains professional relationships with provider community and internal and external customers.
• Conducts self in a professional manner at all times. 
• Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
• Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth.
• Complies with required workplace safety standards.

Knowledge/Skills/Abilities

• Demonstrated ability to communicate, problem solve, and work effectively with people.
• Excellent organizational skill with the ability to manage multiple priorities.
• Work independently and handle multiple projects simultaneously.
• Strong analytical skills.
• Knowledge of applicable state, and federal regulations.
• Knowledge of ICD-9, CPT coding and HCPC.
• SSI, Coordination of benefits, and Third Party Liability programs and integration.
• Familiarity with NCQA standards, state/federal regulations and measurement techniques.
• In depth knowledge of CCA and/or other Case Management tools.
• Ability to take initiative and see tasks to completion.
• Computer skills and experience with Microsoft Office Products.
• Excellent verbal and written communication skills.
• Ability to abide by Molina’s policies.
• Able to maintain regular attendance based upon agreed schedule.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.



Required Education: 
Bachelor’s degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree).
                                                                                                           
Required Experience:     
Three to five years of clinical experience with three or more years of case management experience.                                                                                               
Required Licensure/Certification:
Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing.  A combination of experience and education will be considered in lieu of LCSW or APSW.  Must have valid driver’s license with good driving record and be able to drive locally.                                                                                                                    
Preferred Education:
Master’s degree in Nursing, Health Education or Other Healthcare related field.
Preferred Experience:
More than five years Case Management experience. Medicaid/Medicare Population experience.
Preferred Licensure/Certification:
Certified Case Manager. (CCM), Certified Professional in Healthcare Management Certification (CPHM)  Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification.
 



To all current Molina employees if you are interested in applying for this position please apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.

Molina Healthcare, a FORTUNE 500 company that is nationally recognized and has grown into one of the leaders in providing quality healthcare for financially vulnerable individuals and families. Molina Healthcare is a multi-state healthcare organization with flexible care delivery systems focused exclusively on government-sponsored healthcare programs for low income families and individuals. Currently, Molina Healthcare arranges for the delivery of healthcare services or offers health information management solutions for nearly 4.3 million individuals and families who receive their care through MedicaidMedicare and other government funded programs in 15 states. We continually seek talented individuals who share our values and can contribute to our mission of providing the highest quality health care to those who need it most and are least able to afford it. Become part of the Molina Healthcare family today! Discover extraordinary opportunities for growth.

Molina Benefits

Molina offers a variety of career opportunities across the nation as well as excellent compensation and an attractive benefits package that includes.

  • Medical
  • Dental
  • Vision
  • Short- and long-term disability
  • Flexible spending accounts
  • Life insurance plans
  • 401(k) savings plan with employer match
  • Paid time off
  • Paid holidays
  • Volunteer time off
  • Tuition reimbursement
  • Referral bonuses and more!

 

Molina Healthcare is a Diverse Healthcare Atmosphere & Equal Opportunity Employer (EOE) M/F/D/V.

Job Key Words: RN, Nurse, Nursing, Registered Nurse, Utilization Management,NCQA,(CPHM), Certified Professional in Health Care Quality (CPHQ), Certified Case Manager. (CCM), Managed care, Medicaid/Medicare, Columbus, OH

To apply, please click here