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Molina Healthcare Las Vegas, NV

$92,876 - $181,108 / year

JOB DESCRIPTION Job Summary Provides screening, preventive primary care and medical care services to members - primarily in non-clinical settings where members feel most comfortable, including in-home, community and nursing facilities and “pop up” clinics. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Provides general medical care and care coordination to various and/or specific patient member populations – adult, women’s health, pediatric, and geriatric. • Performs comprehensive evaluations including history and physical exams for gaps in care and preventive assessments. • Addresses both chronic and acute primary care complaints, and demonstrates ability to ascertain medical urgency. • Establishes and documents reasonable medical diagnoses. • Seeks specialty consultation as appropriate. • Orders/performs pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptoms; works within an environment of limited resources and therefore uses diagnostic tests judiciously and appropriately. • Understands when a member's needs are beyond their scope of knowledge and when physician oversight is needed. • Creates and implements a medical plan of care. • Schedules appointments for visits when appropriate. • Provides post-discharge coordination to reduce hospital readmission rates and emergency room utilization. • Performs face-to-face in-person visits in a variety of settings including in-home, skilled nursing facilities, and public locations. • Performs face-to-face visits via alternative modalities based on business need, leadership direction and state regulations. • Orders bulk laboratory orders to target specific member populations. • Performs alternating on-call coverage to triage any urgent lab results and pharmacy inquiries and develops appropriate plans of care. • Participates in community-based “pop up clinics” to build relationships with communities, and address gaps in health care. • Drives up to 120 miles a day on a regular basis to a variety of locations within the assigned region. Drives beyond 120 miles as part of extended mileage may be required on special project days. Special projects may include an overnight hotel stay. • Obtains and maintains cross-state license in other states besides home state based on business need. • Collaborates with fellow nurse practitioners to develop best practices to perform work duties efficiently and effectively. • Actively participates in regional meetings. • May prescribe medications and perform procedures as appropriate. • Performs timely medical records documentation in electronic medical record (EMR) computer system. • On occasion, may be required to walk flights of stairs while carrying up to 50 lbs. of equipment. • Engages in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician to the degree required by state laws. • Local travel required (based upon state/contractual requirements). Required Qualifications • At least 1 year of experience as a nurse practitioner, or equivalent combination of relevant education and experience. • Active and unrestricted national certification from one of the following organizations: American Academy of Nurse Practitioners (AANP) or American Nurses Credentialing Center (ANCC). • Current state-issued license to practice as a Family Nurse Practitioner (FNP). License must be active and unrestricted in state of practice. • Prescriber Drug Enforcement Agency (DEA) license with authority to prescribe per state qualifications. License must be active and unrestricted in state of practice. • Current Basic Life Support (BLS) certification. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements. • 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 demonstrate self-motivation. • Responsive in all forms of communication. • Ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills; 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(s) proficiency, and electronic medical record (EMR) experience. Preferred Qualifications • Experience as a registered nurse or nurse practitioner in a home health, community health or public health setting. • Experience in home health as a licensed clinician, especially in management of chronic conditions. • Experience with underserved populations facing socioeconomic barriers to health care. • Immunization and point of care testing skills. • Bilingual. 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: $92,876 - $181,108 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

$27.73 - $54.06 / hour

Must reside in and be licensed in Illinois. Hours: 9:00-6:00 CST Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/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 reviews to determine medical necessity and appropriate level of care for hospital stays of Molina members. • Processes requests within required timelines. • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote the Molina care model. • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified Professional in Healthcare Management (CPHM). • Recent hospital experience in an intensive care unit (ICU) or emergency room. 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: $27.73 - $54.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

NP

Full-time

1 week ago

Molina Healthcare Coeur d'Alene, ID

$21.60 - $46.81 / hour

For this position we are seeking a Care Manager who lives in Idaho Care manager will support Idaho Medicaid. This position will have a case load and manage members enrolled in this program. We are looking for a Care Manager who have experience working with manage care population and/or case management role and the geriatric population. Excellent computer skills and diligence are especially important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL (30%) in the field to do member visits in the surrounding areas will be required: Idaho - (Mileage is reimbursed) Lewiston, Coeur d’ Alene, Pocatello, Idaho Falls, Twin Falls, Post Fallas Schedule – Monday thru Friday 800 AM to 5 PM MST (No weekends or Holidays) JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. 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 member assessments within regulated timelines, including in-person home visits as required. • Facilitates comprehensive waiver enrollment and disenrollment processes. • Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. • Performs ongoing monitoring of 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 (LTSS) and home and community resources to enhance continuity of care. • Assesses for medical necessity and authorizes all appropriate waiver services. • Evaluates covered benefits and advises appropriately regarding funding sources. • Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services 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 and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. • Identifies critical incidents and develops prevention plans to assure member health and welfare. • Collaborates with licensed care managers/leadership as needed or required. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. •Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Demonstrated knowledge of community resources. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work independently, with minimal supervision and self-motivation. • Ability to demonstrate responsiveness in all forms of communication, and 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. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). Preferred Qualifications • Certified Case Manager (CCM), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice. • Experience working with populations that receive waiver services. 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: $21.6 - $46.81 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.