Overview Opportunity for a Texas licensed RN to join Molina Healthcare to work with Medicare members in the eastern side of the Houston service delivery area. You will complete assessments needed for determining the types of services they are eligible to receive. Mileage is reimbursed as part of our benefits package. Hours are Monday – Friday, 8 AM – 5 PM CST.
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 requirement: 50-75% travel.
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.
State Specific Requirements Virginia: Must have at least one year of experience working directly with individuals with Substance Use Disorders
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)
Additional Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $26.41 - $51.49 / HOURLY.