Overview Molina Healthcare has partnered with iHire to reach top talent for their opening. Positions available in NE Ohio: Cuyahoga, Geauga, Lake, Lorain, Medina and Cleveland.
Responsibilities Completes face-to-face comprehensive assessments of members per regulated timelines.
Facilitates comprehensive waiver enrollment and disenrollment processes.
Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members.
Assesses for medical necessity and authorize all appropriate waiver services.
Evaluates covered benefits and advise appropriately regarding funding source.
Conducts face-to-face or home visits as required.
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 for barriers to care, provides care coordination and assistance to member 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
Conducts medication reconciliation when needed.
Travel required: 50-75%.
Qualifications Required Education Graduate from an Accredited School of Nursing
Required Experience At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports.
1-3 years 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 valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
Preferred Education Bachelor's Degree in Nursing
Preferred Experience 3-5 years in case management, disease management, managed care or medical or behavioral health settings.
1 year experience working with population who receive waiver services.
Preferred License, Certification, Association Active and unrestricted Certified Case Manager (CCM)
Other To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Details Seniority level: Entry level
Employment type: Full-time
Job function: Health Care Provider
Industries: Hospitals and Health Care and Medical Practices