Registered Nurse Job Opportunity
We are looking for a Registered Nurse in Ohio who is licensed to work in the state of Ohio. This position will support our Medicaid Medicare Population (MMP) with members on the Waiver program. The role will involve managing a case load and overseeing members enrolled in this program. We are seeking Registered Nurses with experience in managing care populations or case management roles. Excellent computer skills and diligence are crucial for multitasking between systems, speaking with members on the phone, and entering accurate contact notes. This is a fast-paced position where productivity is important. The role requires field work to conduct assessments with members in their homes. Travel in the field to perform member visits in the surrounding areas will be required: Columbus OH (Mileage is reimbursed). Schedule Monday through Friday 8:00 AM to 5:00 PM EST (No weekends or Holidays).
Job Summary:
Provides support for care management/care coordination long-term services and supports specific activities and collaborates with a multidisciplinary team to coordinate integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to the overarching strategy to provide quality and cost-effective member care.
Essential Job Duties:
- Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
- Facilitates comprehensive waiver enrollment and disenrollment processes.
- Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians, and/or other appropriate health care professionals and member support network to address the member needs and goals.
- Performs ongoing monitoring of 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 (LTSS) and home and community resources to enhance continuity of care.
- Assesses for medical necessity and authorizes all appropriate waiver services.
- Evaluates covered benefits and advises appropriately regarding funding sources.
- Facilitates interdisciplinary care team (ICT) 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 and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns.
- Identifies critical incidents and develops prevention plans to assure member health and welfare.
- May provide consultation, resources, and recommendations to peers as needed.
- Care manager RNs may be assigned complex member cases and medication regimens.
- Care manager RNs may conduct medication reconciliation as needed.
- 25-40% estimated local travel may be required (based upon state/contractual requirements).
Required Qualifications:
- At least 2 years of experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
- Registered Nurse (RN). License must be active and unrestricted in the state of practice.
- Valid and unrestricted drivers license, reliable transportation, and adequate auto insurance for job-related travel requirements.
- Ability to operate proactively and demonstrate detail-oriented work.
- Demonstrated knowledge of community resources.
- Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations.
- Ability to work independently, with minimal supervision and demonstrate 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, and ability to focus on multiple projects simultaneously and adapt to change.
- Excellent problem-solving and critical-thinking skills.
- Strong verbal and written communication skills.
- Microsoft Office suite/applicable software program(s) proficiency.
- In some states, must have at least one year of experience working directly with individuals with substance use disorders.
Preferred Qualifications:
- Certified Case Manager (CCM).
- Experience working with populations that receive waiver services.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.