RN Telehealth Full-time
Molina Healthcare

(RN) Remote Care Manager - Medicare STARS/Quality (MI Based)

Molina Healthcare Detroit, MI, US
$26.41 - $51.49 / hour

JOB DESCRIPTION Job Summary

Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
 

Essential Job Duties 
• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. 
• Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. 
• Conducts telephonic, face-to-face or home visits as required. 
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. 
• 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 to enhance continuity of care. 
• Facilitates interdisciplinary care team (ICT) 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. 
• May provide consultation, resources and recommendations to peers as needed. 
• Care manager RNs may be assigned complex member cases and medication regimens. 
• Care manager RNs may conduct medication reconciliation as needed. 
 

Required Qualifications 
• At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. 
• Registered Nurse (RN). License must be active and unrestricted in state of practice. 
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. 
• Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA). 
• Demonstrated knowledge of community resources. 
• Ability to operate proactively and demonstrate detail-oriented work. 
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. 
• Ability to work independently, with minimal supervision and self-motivation. 
• Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. 
• Ability to develop and maintain professional relationships. 
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. 
• Excellent problem-solving, and critical-thinking skills. 
• Strong verbal and written communication skills. 
• Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. 

Preferred Qualifications 
• Experience closing care gaps (HEDIS measures, medication adherence, HOS surveys).

• Comfort using care management platforms and population health tools.

• Track record of successful member engagement and outreach.

• Understanding of CMS Star Ratings methodology and quality bonus payments.

 


To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $26.41 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Share this job

Share to FB Share to LinkedIn Share to Twitter

Related Jobs

RN Telehealth Full-time
CVS Health

Care Manager RN - Michigan

CVS Health Pontiac, MI
$60,522 - $129,615 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Summary: The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies. Key Responsibilities: 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care. Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs. Provides evidence-based disease management education and support to help the member achieve health goals. Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care. Provides care coordination to support a seamless health care experience for the member. Meticulous documentation of care management activity in the member’s electronic health record. Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition. Identifies and connects members with health plan benefits and community resources. Meets regulatory requirements within specified timelines. The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed. Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members. Essential Competencies and Functions: Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role. Conduct oneself with integrity, professionalism, and self-direction. Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. Familiarity with community resources and services. Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records. Maintain strong collaborative and professional relationships with members and colleagues. Communicate effectively, both verbally and in writing. Excellent customer service and engagement skills. Required Qualifications Must have active and unrestricted Registered Nurse (RN) licensure in the state of MI OR compact licensure in state of residence Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the CM RNrole. Access to a private, dedicated space to conduct work effectively to meet the requirements of the position. Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually. Minimum 3+ years of nursing experience Minimum 2+ years of case management, discharge planning and/or home healthcare coordination experience Preferred Qualifications Experience providing care management for Medicare and/or Medicaid members. Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health. Experience conducting health-related assessments and facilitating the care planning process. Bilingual skills, especially English-Spanish Education Associate’s of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED) Bachelor’s of Science in Nursing (BSN) (PREFERRED) License Must have active and unrestricted Registered Nurse (RN) licensure in the state of MI OR compact licensure in state of residence Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments . We anticipate the application window for this opening will close on: 06/17/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN ER Full-time
McLaren Health Care

Registered Nurse - Emergency Department (Pontiac)

McLaren Health Care Pontiac, MI
Department: Emergency Services Scheduled Bi-Weekly Hours: 72 Daily Work Times: 11a-11:30p Position Summary: The Registered Nurse delivers quality nursing care through the utilization of the nursing process. Works collaboratively with other members of the healthcare team to maintain standards for professional nursing practice. Carries out functions according to hospital policy, the hospital mission, and standards of practice defined by professional and regulatory guidelines. Directs, coordinates and delegates activities in order to foster patient / family centered care. Responsibilities: Assesses the physical, psychosocial, and educational needs of the patient. Plans and implements nursing care according to patient and family needs. Makes appropriate interventions based upon individual patient needs. Evaluates patient responses to nursing interventions. Assumes personal responsibility for quality patient care, patient satisfaction, environment, and professional development. Qualifications: Required: RN licensure BCLS ACLS for required for certain units. Graduate of an approved school of Nursing Preferred: One year experience in department clinical specialty BSN Additional Information Schedule: Full-time Requisition ID: 26004040 Daily Work Times: 11a-11p Hours Per Pay Period: 72 On Call: No Weekends: Yes
RN Psych Full-time
McLaren Health Care

Registered Nurse - Behavioral Health

McLaren Health Care Pontiac, MI
Department: Behavioral Health Scheduled Bi-Weekly Hours: 7a-7:30p Daily Work Times: 72 Position Summary: The Registered Nurse delivers quality nursing care through the utilization of the nursing process. Works collaboratively with other members of the healthcare team to maintain standards for professional nursing practice. Carries out functions according to hospital policy, the hospital mission, and standards of practice defined by professional and regulatory guidelines. Directs, coordinates and delegates activities in order to foster patient / family centered care. Responsibilities: Assesses the physical, psychosocial, and educational needs of the patient. Plans and implements nursing care according to patient and family needs. Makes appropriate interventions based upon individual patient needs. Evaluates patient responses to nursing interventions. Assumes personal responsibility for quality patient care, patient satisfaction, environment, and professional development. Qualifications: Required: RN licensure BCLS ACLS for required for certain units. Graduate of an approved school of Nursing Preferred: One year experience in department clinical specialty BSN Additional Information Schedule: Full-time Requisition ID: 26004046 Daily Work Times: 7a-730p Hours Per Pay Period: 72 On Call: No Weekends: Yes
RN Psych Full-time
McLaren Health Care

Registered Nurse - Behavioral Health

McLaren Health Care Pontiac, MI
Department: Behavioral Health Scheduled Bi-Weekly Hours: 7a-7:30p Daily Work Times: 72 Position Summary: The Registered Nurse delivers quality nursing care through the utilization of the nursing process. Works collaboratively with other members of the healthcare team to maintain standards for professional nursing practice. Carries out functions according to hospital policy, the hospital mission, and standards of practice defined by professional and regulatory guidelines. Directs, coordinates and delegates activities in order to foster patient / family centered care. Responsibilities: Assesses the physical, psychosocial, and educational needs of the patient. Plans and implements nursing care according to patient and family needs. Makes appropriate interventions based upon individual patient needs. Evaluates patient responses to nursing interventions. Assumes personal responsibility for quality patient care, patient satisfaction, environment, and professional development. Qualifications: Required: RN licensure BCLS ACLS for required for certain units. Graduate of an approved school of Nursing Preferred: One year experience in department clinical specialty BSN Additional Information Schedule: Full-time Requisition ID: 26004044 Daily Work Times: 7a-730p Hours Per Pay Period: 72 On Call: No Weekends: Yes
RN Med-Surg Full-time
McLaren Health Care

International Nurse Registered Nurse - Medical Surgical

McLaren Health Care Pontiac, MI
Department: International Nurse Registered Nurse - Medical Surgical Scheduled Bi-Weekly Hours: 72 Daily Work Times: 7:00am - 7:30pm Position Summary: The Registered Nurse delivers quality nursing care through the utilization of the nursing process. Works collaboratively with other members of the healthcare team to maintain standards for professional nursing practice. Carries out functions according to hospital policy, the hospital mission, and standards of practice defined by professional and regulatory guidelines. Directs, coordinates and delegates activities in order to foster patient / family centered care. Responsibilities: Assesses the physical, psychosocial, and educational needs of the patient. Plans and implements nursing care according to patient and family needs. Makes appropriate interventions based upon individual patient needs. Evaluates patient responses to nursing interventions. Assumes personal responsibility for quality patient care, patient satisfaction, environment, and professional development. Qualifications: Required: RN licensure BCLS ACLS for required for certain units. Graduate of an approved school of Nursing Preferred: One year experience in department clinical specialty BSN Additional Information Schedule: Full-time Requisition ID: 26004121 Daily Work Times: 0700-1930 Hours Per Pay Period: 72 On Call: No Weekends: Yes