Care Manager (RN)- Medicare Stars

Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment. Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals. Conducts telephonic, face-to-face or home visits as required. Performs ongoing monitoring of care plan to evaluate effectiveness. Maintains ongoing member caseload for regular outreach and management. Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources. Facilitates interdisciplinary care team (ICT) meetings. 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. May provide consultation, resources and recommendations to peers. May be assigned complex member cases and medication regimens. May conduct medication reconciliation as needed. 25-40% estimated local travel may be required.