Company Description

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Description

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.

Requirements

REQUIRED EDUCATION: LVN/LPN/licensure 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 , licensed for the state of South Carolina PREFERRED EXPERIENCE: 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

Responsibilities

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

Help & Resources

Apply Now