Health Management Care Manager
• Must be a current resident of South Carolina
Job Description
Job Summary
The Molina Population Health Management Case Manager uses clinical judgment, knowledge, and direct hands-on member care experience to clinically evaluate the member based on formal assessment and determine the next step(s) for care. Care is then provided directly or referred / escalated. HM CM staff work to ensure that members 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.
Job Duties
• Based on clinical assessment and member reported health care concerns, use clinical judgment to provide care management or refer members to a higher level of care.
• Identify patient needs, close health care gaps, develop action plan and prioritize goals and educate patients best practice to manage medical needs.
• Provide condition specific education designed to assist members and their families in better understanding specific chronic health conditions, how to manage symptoms to prevent conditions from progressing and adopting healthy lifestyle behaviors.
• Provide general member education to assist with self-management goals; disease management or acute condition and provide indicated contingency plan.
• Assess for barriers to care, provides care coordination and assistance to member to address concerns.
• Act as an advocate for patients to guide them through the health care system for transition planning and longitudinal care.
• Reinforce medication adherence and education. Monitor patient reactions to medications and treatments.
• Engage patient, family, and caregivers telephonically to assure that a well-coordinated action plan is established and continually assess health status.
• Perform ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintain ongoing member case load for regular outreach and management.
• Use motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• May facilitate interdisciplinary care team meetings and informal ICT collaboration.
• Collaborate with RN case managers/supervisors as needed or required
Job Qualifications
REQUIRED EDUCATION:
LVN/LPN/LCSW/LPC/LCPC licensure, Registered Dietician OR equivalent direct hands on clinical experience with a Master’s degree in social science, psychology, gerontology, public health, social work or related area
Required Experience/Knowledge, Skills & Abilities
1-3 years in direct patient care, case management, disease management, managed care in medical or behavioral health settings.
Required License, Certification, Association
LVN/LPN/LCSW/LPC/LCPC licensure, Registered Dietician OR equivalent direct hands on clinical experience with a Master’s degree in social science, psychology, gerontology, public health, social work or related area
Preferred Experience
3-5 years in case management, disease management, managed care or medical or behavioral health settings.
Preferred License, Certification, Association
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.
Pay Range: $24 - $46.81 / HOURLY
• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Apply Now
Apply Now
Job Description
Job Summary
The Molina Population Health Management Case Manager uses clinical judgment, knowledge, and direct hands-on member care experience to clinically evaluate the member based on formal assessment and determine the next step(s) for care. Care is then provided directly or referred / escalated. HM CM staff work to ensure that members 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.
Job Duties
• Based on clinical assessment and member reported health care concerns, use clinical judgment to provide care management or refer members to a higher level of care.
• Identify patient needs, close health care gaps, develop action plan and prioritize goals and educate patients best practice to manage medical needs.
• Provide condition specific education designed to assist members and their families in better understanding specific chronic health conditions, how to manage symptoms to prevent conditions from progressing and adopting healthy lifestyle behaviors.
• Provide general member education to assist with self-management goals; disease management or acute condition and provide indicated contingency plan.
• Assess for barriers to care, provides care coordination and assistance to member to address concerns.
• Act as an advocate for patients to guide them through the health care system for transition planning and longitudinal care.
• Reinforce medication adherence and education. Monitor patient reactions to medications and treatments.
• Engage patient, family, and caregivers telephonically to assure that a well-coordinated action plan is established and continually assess health status.
• Perform ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintain ongoing member case load for regular outreach and management.
• Use motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• May facilitate interdisciplinary care team meetings and informal ICT collaboration.
• Collaborate with RN case managers/supervisors as needed or required
Job Qualifications
REQUIRED EDUCATION:
LVN/LPN/LCSW/LPC/LCPC licensure, Registered Dietician OR equivalent direct hands on clinical experience with a Master’s degree in social science, psychology, gerontology, public health, social work or related area
Required Experience/Knowledge, Skills & Abilities
1-3 years in direct patient care, case management, disease management, managed care in medical or behavioral health settings.
Required License, Certification, Association
LVN/LPN/LCSW/LPC/LCPC licensure, Registered Dietician OR equivalent direct hands on clinical experience with a Master’s degree in social science, psychology, gerontology, public health, social work or related area
Preferred Experience
3-5 years in case management, disease management, managed care or medical or behavioral health settings.
Preferred License, Certification, Association
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.
Pay Range: $24 - $46.81 / HOURLY
• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Apply Now
Apply Now