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JOB DESCRIPTION Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. We are seeking a candidate with a WA state RN licensure to support the Washington State Plan. Candidates with knowledge of the criminal justice system, or carceral facility knowledge/work experience are highly preferred. Candidates must have previous case management, discharge planning or care coordination experience. Bilingual candidates that speak fluent Spanish are encouraged to apply to support our diverse communities. Further details to be discussed during our interview process. Remote position Work schedule: Monday- Friday: 7:30am- 4:30pm PST. RN WA licensure required KNOWLEDGE/SKILLS/ABILITIES • 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 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. #PJHS Pay Range: $26.41 - $61.79 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Looking for a RN that has a current active unrestricted license This a remote role and can sit anywhere within the United States. Work Schedule Monday to Friday - operation hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers. Job Duties • Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which an appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing., • Identifies and reports quality of care issues., • Assists with Complex Claim review including DRG Validation, Itemized Bill Review, Appropriate Level of Care, Inpatient Readmission, and any opportunity identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience, • Documents clinical review summaries, bill audit findings and audit details in the database, • Provides supporting documentation for denial and modification of payment decisions, • Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care., • Reviews medically appropriate clinical guidelines and other appropriate criteria with Medical Directors on denial decisions., • Supplies criteria supporting all recommendations for denial or modification of payment decisions., • Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals., • Provides training and support to clinical peers., • Identifies and refers members with special needs to the appropriate Molina Healthcare program per policy/protocol. JOB QUALIFICATIONS Graduate from an Accredited School of Nursing REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: • Minimum 3 years clinical nursing experience., • Minimum one year Utilization Review and/or Medical Claims Review., • Minimum two years of experience in Claims Auditing, Medical Necessity Review and Coding experience Active, unrestricted State Registered Nursing (RN) license in good standing. PREFERRED EDUCATION: Bachelors’s Degree in Nursing or Health Related Field PREFERRED EXPERIENCE: Nursing experience in Critical Care, Emergency Medicine, Medical Surgical, or Pediatrics. Advanced Practice Nursing. Billing and coding experience. PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified Professional in Healthcare Quality or other healthcare certification. 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. Pay Range: $26.41 - $61.79 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. KNOWLEDGE/SKILLS/ABILITIES • Follows member throughout a 30-day program that starts at hospital admission and continues through transitions from the acute setting to other settings, including nursing facility placement and private home, with the goal of reduced readmissions., • Ensures safe and appropriate transitions by collaborating with hospital discharge planners, as well as with hospitalists, outpatient providers, facility staff, and family/support network, as needed or at the request of member., • Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required., • Works with participating ancillary providers, public agencies, or other service providers to make sure necessary services and equipment are in place for a safe transition., • Conducts face-to-face visits of all members while in the hospital and home visits of high-risk members post-discharge., • Coordinates care and reassesses member's needs using the Coleman Care Transitions Model recommended post-discharge timeline., • Educates and supports member focusing on seven primary areas (ToC Pillars): medication management, use of personal health record, follow up care, signs and symptoms of worsening condition, nutrition, functional needs and or Home and Community-based Services, and advance directives., • 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., • Facilitates interdisciplinary care team meetings and informal ICT collaboration., • 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 will conduct medication reconciliation when needed. JOB QUALIFICATIONS Required Education Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred. Required Experience 1-3 years hospital discharge planning or home health. 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. CALIFORNIA State Specific Requirements: Must be licensed currently for the state of California. California is not a compact state. Preferred Education Bachelor's Degree in Nursing Preferred Experience 3-5 years hospital discharge planning or home health. Preferred License, Certification, Association Active, unrestricted Transitions of Care Sub-Specialty Certification and/or Certified Case Manager (CCM) **Work schedule :M - F Pacific Business Hours Candidates can live anywhere in the USA but must work PACIFIC hours. California or West Coast USA Residents preferred **Remote, no travel required. 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. Pay Range: $30.37 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type:* Full time Day Shift This position is an ambulatory care registered nurse who will work focusing on our Trinity Health medical group patients. Certification in Case Man

Communication: The RN communicates effectively in all areas of practice Collaboration: The RN collaborates with healthcare consumer and other key stakeholders in the conduct of nursing practice. Evidence-Based Practice and Research: The RN integrates evidence and research findings into practice Qual

Employment Type:* Full time Day Shift RN Care Manager - Full Time - Eddy SeniorCare (Latham) Eddy SeniorCare has a rewarding opportunity for an RN Case Manager to work out of our 385 Watervliet Shaker Road, Latham location! PACE is a unique program on the forefront of trends

Administer on-going care and case management for each patient, provide necessary follow-up as directed by the Clinical Manager. Coordinate appropriate care, encompassing various healthcare personnel (such as Physical Therapists, Occupational Therapists, Home Health Aides, and external providers). Cl

Employment Type:* Full time Day Shift This position is an ambulatory care registered nurse who will work focusing on our Trinity Health medical group patients. Certification in Case Man

RN Nurse Assessor/Case Manager (BSN). RN Nurse Assessor/Case Manager,. If you want to be part of the only safety net hospital in Nassau County, we have an amazing opportunity for a full-time Nurse Assessor/Case Manager.

Employment Type:* Full time Day Shift RN Care Manager - Full Time - Eddy SeniorCare (Latham) Eddy SeniorCare has a rewarding opportunity for an RN Case Manager to work out of our 385 Watervliet Shaker Road, Latham location! PACE is a unique program on the forefront of trends

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. Active, unrestricted Certified Case Manager (CCM).

Employment Type:* Full time Day Shift This position is an ambulatory care registered nurse who will work focusing on our Trinity Health medical group patients. Experience Requirements:*

RN Nurse Assessor/Case Manager,. RN Nurse Assessor/Case Manager (BSN). If you want to be part of the only safety net hospital in Nassau County, we have an amazing opportunity for a full-time Nurse Assessor/Case Manager.

RN Care Manager - Full Time - Eddy SeniorCare (Latham) Eddy SeniorCare has a rewarding opportunity for an RN Case Manager to work out of our 385 Watervliet Shaker Road, Latham location! PACE is a unique program on the forefront of trends in healthcare, combining an insurance role (we are the Medicar

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. RN WA licensure required Completes comprehensive assessme

Hybrid/Remote options once trained. Certification in Case Management (CCM) preferred.

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. RN WA licensure required KNOWLEDGE/SKILLS/ABILITIES *

Employment Type:* Full time Day Shift RN Care Manager - Full Time - Eddy SeniorCare (Latham) Eddy SeniorCare has a rewarding opportunity for an RN Case Manager to work out of our 385 Watervliet Shaker Road, Latham location! PACE is a unique program on the forefront of trends

RN Nurse Assessor/Case Manager (BSN). RN Nurse Assessor/Case Manager,. If you want to be part of the only safety net hospital in Nassau County, we have an amazing opportunity for a full-time Nurse Assessor/Case Manager.

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. Active, unrestricted Certified Case Manager (CCM).

Employment Type:* Full time Day Shift This position is an ambulatory care registered nurse who will work focusing on our Trinity Health medical group patients. Certification in Case Man

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. The Registered Nurse Care Manager at Williamsbridge Center is responsible for providing care and support to residents in a skilled nursing facility. Williamsbridge Center is hiring a Registered Nurse (RN) for our Sk

Employment Type:* Full time Day Shift RN Care Manager - Full Time - Eddy SeniorCare (Latham) Eddy SeniorCare has a rewarding opportunity for an RN Case Manager to work out of our 385 Watervliet Shaker Road, Latham location! PACE is a unique program on the forefront of trends

The Case Manager must have very strong interpersonal skills and the ability to build relationships with stakeholders, including staff and external partners, with emotional maturity. All staff must bring to the organization the traits necessary to nurture our internal and external relationships. The

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. The Registered Nurse Care Manager at Williamsbridge Center in Bronx, NY provides comprehensive nursing care and support to residents in a skilled nursing facility. Williamsbridge Center is hiring a Registered Nurse

The Case Manager must have very strong interpersonal skills and the ability to build relationships with stakeholders, including staff and external partners, with emotional maturity. All staff must bring to the organization the traits necessary to nurture our internal and external relationships. The

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. As a Registered Nurse (RN), Provide advice & support to the Residents and their families. Current State Registered Nurse RN License.

Registered Nurse Unit Manager, RN coordinates resident care in accordance with State DOH regulations. Registered Nurse Unit Manager, RN will organize, oversee and supervise assigned unit activities and staff assignments. Registered Nurse Unit Manager, RN will assist other staff members in completion

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. As a Registered Nurse (RN), Provide advice & support to the Residents and their families. Current State Registered Nurse RN License.

The Case Manager must have very strong interpersonal skills and the ability to build relationships with stakeholders, including staff and external partners, with emotional maturity. A Case Manager administers skilled nursing care to patients on an intermittent basis in their place of residence. All

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. The Registered Nurse Care Manager is responsible for providing comprehensive care and support to residents in a skilled nursing facility, ensuring their safety and well-being through monitoring, documentation, and a

Registered Nurse Unit Manager, RN will organize, oversee and supervise assigned unit activities and staff assignments. Registered Nurse Unit Manager, RN will communicate to the Interdisciplinary Team members any pertinent resident findings. Registered Nurse Unit Manager, RN Job Summary.

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. Current State Registered Nurse RN License. Registered Nurse, Case Management, Skilled Nursing, Patient Care, Healthcare, Long-Term Care, Medication Administration, Infection Control, Multidisciplinary Team, Bronx NY

The Case Manager must have very strong interpersonal skills and the ability to build relationships with stakeholders, including staff and external partners, with emotional maturity. A Case Manager administers skilled nursing care to patients on an intermittent basis in their place of residence. All

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. Williamsbridge Center is hiring a Registered Nurse (RN) for our Skilled Nursing Facility in Bronx, NY. As a Registered Nurse (RN), Provide advice & support to the Residents and their families.

The Case Manager must have very strong interpersonal skills and the ability to build relationships with stakeholders, including staff and external partners, with emotional maturity. All staff must bring to the organization the traits necessary to nurture our internal and external relationships. The

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. The ideal candidate will possess strong communication skills, a current RN license, and a commitment to fostering a nurturing environment for residents. Williamsbridge Center is hiring a Registered Nurse (RN) for ou

The Case Manager must have very strong interpersonal skills and the ability to build relationships with stakeholders, including staff and external partners, with emotional maturity. A Case Manager administers skilled nursing care to patients on an intermittent basis in their place of residence. All

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. As a Registered Nurse (RN), Provide advice & support to the Residents and their families. Current State Registered Nurse RN License.

Registered Nurse Unit Manager, RN Job Summary. Registered Nurse Unit Manager, RN perform professional supervision, guidance and direction to staff in both clinical and personnel issues on the Sub-Acute (Short Term Unit). Registered Nurse Unit Manager, RN will organize, oversee and supervise assigned

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. As a Registered Nurse (RN), Provide advice & support to the Residents and their families. Current State Registered Nurse RN License.

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. The Registered Nurse Care Manager at Williamsbridge Center is responsible for providing comprehensive care and support to residents in a skilled nursing facility. The ideal candidate will possess strong communicatio