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Inpatient Review (RN) Case Manager : NIGHT SHIFT California Pacific Hours

Molina Healthcare Long Beach, California; San Jose, California; Ventura, California; Los Angeles, California; San Francisco, California; Sacramento, California; Apple Valley, California; Victorville, California; Riverside, California; San Bernardino, California; San Diego, California Job ID 2027979
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As a Case Manager, you will work with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential.

  • Full Time
  • Level: Mid-Level
  • Travel: Yes

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Success Profile

What makes you a successful Case Manager at Molina Healthcare? Check out the traits we're looking for and see if you're the right fit.

  • Consultative
  • Patient
  • Analytical
  • Quick-Thinking
  • Compassionate
  • Problem-Solver

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I love working at a company that sees our members as people not numbers and allow employees to provide individual care to meet the member’s needs.

-Lori K. MS, BSW, CADC, Case Manager

If they feel someone cares about them, they are more likely to care for themselves, and their health, in return. Sometimes we have to be their only friend.

-Joanne J., Case Manager

A member’s care is enhanced when their care providers think deeply about their situation and then offer assistance and guidance.

-Brent A., Case Manager

Benefits

  • Insurance

    Medical · Dental · Vision
    Group & Voluntary Life Insurance
    Aflac · Pet Health · Identity Theft
    Auto & Home Insurance

  • Savings

    Flexible Spending Accounts
    401K · Roth 401K
    Employee Stock Purchase Plan

  • Career Growth

    Continuing Education Units
    Education Reimbursement

  • Time Off

    Paid Time Off
    Volunteer Time Off
    Company Holidays

  • Additional Perks

    Legal Assistance Plan
    Employee Assistance & Well Being Programs
    Employee Perks Platform
    Rideshare Portal

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Responsibilities

EMERGENCY ROOM ADMISSIONS REVIEW NURSE 

PERMANENT SHIFT WILL BE  : 12 hour NIGHT SHIFT: 7:30PM (in the evening) - 08:30AM  (in the morning) PACIFIC HOURS NON EXEMPT, 3 days a week will rotate. 

This department runs 24 / 7 / 365 days a year. Rotating weekends and holidays will be required.   This position supports our California Health Plan. Candidates can live anywhere in the USA if they have a valid CALIFORNIA RN license must work  the shift hours as posted. CALIFORNIA IS NOT a compact state at this time. Out of state candidates will need to work PACIFIC HOURS.

TRAINING SCHEDULE WILL BE  Monday thru Friday  8:30AM to 5:30PM PACIFIC throughout a 2 - 3 month training and then will move to a 3 day/12 hour shift from then on.

Previous experience with Emergency Room Utilization Management / Utilization Review is preferred for this role. Experience with Case Management is a plus. 

JOB DESCRIPTION

Job Summary
Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients 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.

KNOWLEDGE/SKILLS/ABILITIES

  • Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
  • Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
  • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
  • Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.
  • Processes requests within required timelines.
  • Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.
  • Requests additional information from members or providers in consistent and efficient manner.
  • Makes appropriate referrals to other clinical programs.
  • Collaborates with multidisciplinary teams to promote Molina Care Model.
  • Adheres to UM policies and procedures.
  • Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.

JOB QUALIFICATIONS

Required Education
Graduate from an Accredited School of Nursing.
Required Experience
3+ years hospital acute care/medical experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements:

CALIFORNIA RN licensure is immediately required 


Preferred Education
Bachelor's Degree in Nursing
Preferred Experience
Recent hospital experience in ICU, Medical, or ER unit.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).

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: $30.37 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

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 Type: Full Time Posting Date: 09/21/2024

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