Molina Healthcare

RN Restrictions Case Manager

  • Molina Healthcare
  • Midvale, UT
  • 12 days ago

Advertisement

Job Description

We are seeking a RESTRICTIONS CASE MANAGER who must live in the state of UTAH, and must be licensed for the state of UTAH in any of the following: RN, SSW, LCSW, CSW, or SUDC.

Excellent computer skills and attention to detail are very important to multi task between systems, talk with members on the phone, and enter accurate contact notes.

This is a fast paced position.

This is remote position and you may work from home.

Some local travel into our office may be required.

This Case Manager is responsible for extensive research into the members claim history; will review every claim prior to any member outreach and communicate to DOH so that the state is aware of restricted members.

Schedule: Monday thru Friday 8:00AM to 4:30PM / 30 minute lunch break.

Flex start time is OK.

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) Restriction works with the Utah Department of Health, members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high utilization rates .

HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

Extensively researches members claim history for indicators of over utilization per regulated criteria to determine who may qualify for restriction based on clinical judgment, and changes in member's health or psychosocial wellness.

Develops and implements a case management 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.

Completes comprehensive assessments of members per regulated timelines

Manages membership as outline by regulatory guidelines and communicates with the Utah Department of Health to report restriction eligibility.

Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

Maintains ongoing member case load for regular outreach and management.

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.

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 concerns.

RNs provide consultation, recommendations and education as appropriate to non-RN case managers.

RNs are assigned cases with members who have complex medical conditions and medication regimens

RNs conduct medication reconciliation when needed

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing.

Bachelor's Degree in Nursing preferred.

Required Experience

1-3 years in case management, disease management, managed care or medical or behavioral health settings.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

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.

Preferred License, Certification, Association

Active, unrestricted Certified Case Manager (CCM)

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.

Similar Jobs