Care Manager - Remote

About The Company

Molina Healthcare is a leading health insurance provider dedicated to delivering high-quality, accessible healthcare solutions to diverse populations. With a focus on member-centered care, Molina Healthcare strives to improve health outcomes through innovative programs and a comprehensive network of healthcare professionals. The company is committed to fostering an inclusive and supportive work environment that values diversity, professional growth, and community engagement. As an organization that emphasizes integrity, innovation, and excellence, Molina Healthcare continues to expand its reach and impact in the healthcare industry, ensuring that members receive the care they need in a compassionate and cost-effective manner.

About The Role

The Care Manager RN plays a vital role within Molina Healthcare’s care management team, providing support for care coordination and long-term services and supports (LTSS). This position involves collaborating with multidisciplinary teams to deliver integrated and personalized care plans for members with high-need potential. The Care Manager RN is responsible for conducting comprehensive assessments, developing tailored care strategies, and monitoring progress to ensure members achieve their health and well-being goals. The role requires proactive engagement with members, caregivers, healthcare providers, and community resources to promote continuity of care and address barriers that may impede health outcomes. The Care Manager RN also facilitates interdisciplinary team meetings, evaluates medical necessity, and advocates for appropriate services and funding sources. This position may require local travel of approximately 25-40% to meet members in their communities and provide in-home assessments or follow-up visits. The role demands a compassionate, detail-oriented professional capable of working independently within a dynamic healthcare environment.

Qualifications

• Minimum of 2 years of experience in healthcare, including at least 1 year in care management, managed care, or a medical/behavioral health setting.
• At least 1 year of experience working with persons with disabilities, chronic conditions, substance use disorders, or long-term services and supports (LTSS), or an equivalent combination of relevant education and experience.
• Active and unrestricted Registered Nurse (RN) license in the state of practice.
• Valid driver’s license with reliable transportation and adequate auto insurance for job-related travel.
• Proven ability to operate proactively and demonstrate attention to detail.
• Strong knowledge of community resources and healthcare systems.
• Ability to adapt communication and work style to diverse populations and settings.
• Self-motivated with the capacity to work independently with minimal supervision.
• Excellent communication skills, both verbal and written.
• Proficiency in Microsoft Office Suite and applicable healthcare software.
• In certain states, at least one year of experience working directly with individuals with substance use disorders is preferred.
  
  

Responsibilities

• Complete comprehensive member assessments within regulated timelines, including in-home visits as necessary.
• Facilitate waiver enrollment and disenrollment processes efficiently and accurately.
• Develop and implement individualized care plans, including waiver service plans, in collaboration with members, caregivers, healthcare providers, and support networks.
• Monitor and evaluate the effectiveness of care plans, documenting interventions, progress toward goals, and making necessary adjustments.
• Promote integration of behavioral health, LTSS, and community resources to ensure seamless care delivery.
• Assess medical necessity and authorize appropriate waiver services based on member needs.
• Evaluate covered benefits and advise members on funding options and eligibility.
• Lead interdisciplinary care team (ICT) meetings for service approval or denial and foster collaboration among team members.
• Utilize motivational interviewing and clinical guideposts to educate, motivate, and support members in making health-related changes.
• Identify and address barriers to care, including psycho/social, financial, and medical obstacles, providing necessary assistance and care coordination.
• Develop prevention plans for critical incidents to safeguard member health and welfare.
• Provide consultation, resources, and support to peers as needed.
• Manage complex cases, including medication regimens, and conduct medication reconciliation when necessary.
• Travel locally up to 25-40% to meet with members and conduct assessments in community settings.
  
  

Benefits

• Competitive salary and comprehensive benefits package.
• Opportunities for professional development and career advancement.
• Health, dental, and vision insurance coverage.
• Paid time off and holiday leave.
• Retirement savings plans with company contributions.
• Supportive work environment that values diversity and inclusion.
• Flexible work arrangements where applicable.
  
  

Equal Opportunity

Molina Healthcare is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based on race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. All qualified applicants are encouraged to apply, and accommodations are available upon request for candidates participating in the application process.