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Molina Healthcare Case Manager (RN)- Waltham, MA in Waltham, Massachusetts


Job Summary

Molina Healthcare Services (HCS) works with members, providers, and multidisciplinary team members to assess, facilitate, plan,20 and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. Working between Clinical and Provide Relations/Sales to increase the member experience.


  • Facilitates interdisciplinary care team meetings and informal ICT collaboration.

  • Coordinate trainings and vendors to speak with NCM’s for further education

  • Review new hires documentation for training purposes

  • Be a resource for challenging Case Management cases

  • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.

  • Works closely with Provider Services staff to outreach and educate the provider network on proper coding practices.

  • Ability to work with vendors/providers nad provide onsite visits if needed

  • Assists with relationship building strategies and opportunities for growth through provider relationships nad community events

  • Collaborate with health plans and Risk Adjustment Analytics Reporting to monitor completed provider and member assessments to ensure annual goals are achieved

  • Innovative thinker and ability to independently implement ideas

  • Excellent influencing and negotiating skills

  • Abstract records based on dates of service for the retrospective chart review activities

  • Implements project plans related to initiatives to improve plan risk score performance.

  • Monitors performance and evaluate results of risk adjustment initiatives.

  • Oversees the entire risk adjustment process including, but not limited to, tracking, proofing, following through corporate approval process, and any necessary provider follow up

  • Assists with relationship building strategies and opportunities for financial growth through risk score improvement initiatives.

  • Identifies, develops and implements provider/member programs specific to risk score improvement.

  • Research and resolve contact information discrepancies for various member populations

  • Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

  • 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.

  • Assesses for barriers to care, provides care coordination and assistance to member to address concerns.

  • RNs provide consultation, recommendations, and education as appropriate to non-RN/RN case managers.


Required Education

Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

1-3 years in case management, disease management, managed care or medical or behavioral health settings.

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.

Preferred Education

Bachelor's Degree in Nursing

Preferred Experience

3-5 years in case management, disease management, managed care or medical or behavioral health settings.

Preferred License, Certification, Association

Active, unrestricted Certified Case Manager (CCM)

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.