Care Manager, Health Management

JOB DESCRIPTION Job Summary

Provides support for health management activities within the care management/care coordination functions. Collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum, including behavioral health, long-term care, and population health-related education and services for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Based on clinical assessment and member reported health care concerns, uses clinical judgment to provide care management or refer members to a higher level of care.
• Identifies member needs, closes health care gaps, develops action plans and prioritizes goals, and educates members on best practices to manage medical needs.
• Provides 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.
• Provides general member education to assist with self-management goals, disease management or acute conditions, and provide indicated contingency plan.
• Assesses for barriers to care, and provides care coordination and assistance to members to address concerns.
• Acts as an advocate for members to guide them through the health care system for transition planning and longitudinal care.
• Reinforces medication adherence and education; monitors member reactions to medications and treatments.
• Engages member, family, and caregivers telephonically to ensure that a well coordinated action plan is established and continually assesses health status.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member caseload for regular outreach and management.
• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• May facilitate interdisciplinary care team (ICT) meetings and informal ICT collaboration.
• Collaborates with registered nurse care managers/leaders as needed or required.

Required Qualifications

• At least 2 years experience in health care, including at least 1 year of experience in a direct patient care, and/or managed care, care management, or behavioral health setting, or equivalent combination of relevant education and experience.

• Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Practical Counselor (LPC), or Registered Dietician (RD). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.

• Demonstrated knowledge of community resources.

• Proactive and detail-oriented.

• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, 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 with individuals.

• 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.

Preferred Qualifications

• Certified Case Manager (CCM).

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