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Complex Case Mgr II


Molina Healthcare Inc.

is among the most experienced managed healthcare companies serving patients who have traditionally faced barriers to quality healthcare-including individuals covered under Medicaid, and Medicare, the Healthy Families Program, the State Children's Health Insurance Program (SCHIP) and other government-sponsored health insurance programs.

Currently we provide healthcare assistance to approximately 1.4 million members in sixteen (16) states.

Molina has health plans in California, Indiana, Michigan, New Mexico, Ohio, Texas, Utah, Washington, Florida, Louisiana, Idaho, Maine, New Jersey, West Virginia, Virginia, Wisconsin and as well as 19 primary care clinics located in Northern and Southern California.

The company's corporate headquarters are in Long Beach, California.
Molina Healthcare is a publicly traded Fortune 1000 company with approximately 4,500 employees and revenues of $3.6 billion.
RN Complex Case Manager
POSITION SUMMARY
Responsible for the assessment, planning implementation, coordination, monitoring, and evaluation of case management services.
REQUIRED SKILLS AND QUALIFICATIONS
Education
· Registered Nursing Degree required
· Bachelor’s Degree in Nursing preferred
· Case Management Certificate preferred
Experience
· Minimum 2 years Medical Case Management experience
· Minimum 1 year Public Health experience
· Minimum 2 years critical care and/or med-surg experience
· Knowledge of applicable state, federal and third party regulations and standards
· Background in discharge planning and home health
Special Skills or Knowledge
· Knowledge of a variety of clinical areas of medical treatment
· Knowledge of hospital/patient care facilities, current practices, procedures, acceptable medical treatment and diagnoses
· Skill to learn company policies and procedures as they relate to hospital authorization/denials, physician review, appeals, etc.
· Skill to successfully apply established guidelines and regulations to specific and individual situations
· Skill in both oral and written communications to ensure the accurate transferal of information and to build rapport that will ensure the trust, confidence and cooperation of others in a work situation
· Skill in establishing and maintaining a variety of records necessary to provide complete information and documentation for relevant and appropriate medical determination
· Skill to establish and maintain effective work relationships with those contacted in the performance of required duties
· Proficiency with PC-based computer systems, ability to learn new information systems and software
· Excellent organizational skills
Licensure/Certification
· Valid California State Register Nursing license (BSN preferred)
· Certified Case Manager (CCM) Certification preferred
PRINCIPLE ACCOUNTABILITIES
· Identifies, assesses and manages medi...

 


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