Case Manager II

The Judge Group
November 21, 2020
Houston, TX
Job Type


Location: Houston, TX
Description: Our client is currently seeking a Case Manager II

Job Summary:
Must have requirements for the position: Active TX RN License; STAR+PLUS and/or home health experience preferred. Must have at least 2 years of RN clinical experience. Computer skills required. Dependable transportation and auto insurance is required to complete face to face visits once resumed.

Day to day responsibilities include:
• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment.
• Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
• Conducts face-to-face or home visits as required.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member case load for regular outreach and management.
• Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for Molina members.
• Facilitates interdisciplinary care team meetings and informal ICT collaboration.
• 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 to member to address concerns.
• 25- 40% local travel required.
• RNs provide consultation, recommendations and education as appropriate to non-RN case managers.
• RNs are assigned cases with members who have complex medical conditions and medication regimens
• RNs conduct medication reconciliation when needed.

 Responsible for health care management and coordination of Molina Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes. Works with members to create and implement an integrated collaborative plan of care. Coordinates and monitors Molina members progress and services to ensure consistent cost effective care that complies with Molina policy and all state and federal regulations and guidelines. 
Essential Functions: 
• Provides case management services to members with chronic or complex conditions including: 
o Proactively identifies members that may qualify for potential case management services. 
o Conducts assessment of member needs by collecting in-depth information from Molinas information system, the member, members family/caregiver, hospital staff, physicians and other providers. o Identifies, assesses and manages members per established criteria. 
o Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
 o Performs ongoing monitoring of the plan of care to evaluate effectiveness. 
o Documents care plan progress in Molinas information system. 
o Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes. 
o Measures the effectiveness of interventions to determine case management outcomes. 
• Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Molina members. 
• Conducts face to face or home visits as required. 
• Maintains department productivity and quality measures. 
• Manages and completes assigned work plan objectives and projects in a timely manner. 
• Demonstrates dependability and reliability. 
• Maintains effective team member relations. 
• Adheres to all documentation guidelines activities. 
• Attends regular staff meetings. 
• Participates in Interdisciplinary Care Team (ICT) meetings. 
• Assists orientation and mentoring of new team members as appropriate. 
• Maintains professional relationships with provider community and internal and external customers. 
• Conducts self in a professional manner at all times. 
• Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. 
• Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth. 
• Complies with required workplace safety standards. 
• Demonstrated ability to communicate, problem solve, and work effectively with people. 
• Excellent organizational skill with the ability to manage multiple priorities. • Work independently and handle multiple projects simultaneously. 
• Strong analytical skills. 
• Knowledge of applicable state, and federal regulations. 
• Knowledge of ICD-9, CPT coding and HCPC. 
• Knowledge of SSI, Coordination of benefits, and Third Party Liability programs and integration. 
• Familiarity with NCQA standards, state/federal regulations and measurement techniques. 
• In depth knowledge of CCA and/or other Case Management tools. 
• Ability to take initiative and see tasks to completion. 
• Computer skills and experience with Microsoft Office Products. 
• Excellent verbal and written communication skills. 
• Ability to abide by Molinas policies. 
• Able to maintain regular attendance based upon agreed schedule. 
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). 
• Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers. 
Required Education: Bachelors Degree in Social Work or Health Education (a combination of experience and education will be considered in lieu of degree). 
Required Experience: 2-4 years of clinical experience with Case Management experience. Required Licensure/Certification: Must have valid drivers license with good driving record and be able to drive locally.
If qualified and interested, please send updated resume to Mason Voge at [Click Here to Email Your Resumé]!

Contact: [Click Here to Email Your Resumé]

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