Molina Healthcare Inc. Career Opportunities
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Complex Case Manager
OH - Columbus
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Opportunity Snapshot

If you want to challenge yourself professionally while helping those who need a high level of care, this is your opportunity to join a talented and experienced team of Complex Case Managers as we expand our staff at our Columbus, Ohio location.  As a Complex Case Manager you will work on the telephone, providing critical services for members with chronic and complex medical, mental and sometimes even social needs.  You will be part of a multidisciplinary team with other professionals  and will collaborate with both internal and external resources to obtain improved health outcomes.These are the more challenging cases with high risk members usually requiring extensive use of resources throughout multiple segments of the healthcare system and community, and requiring significantly greater coordination.  If you’re looking for the energy of a new expansion initiative, the stability of a strong company with a rich history of success where you can enjoy the work/life balance of traditional business hours, and have the opportunity to feel good about delivering an essential service that can make a viable difference in members’ lives, this role could be your perfect fit.

Since its founding more than 30 years ago, Molina Healthcare has grown into one of the leaders in providing quality healthcare for financially vulnerable individuals and families. Currently, Molina Healthcare arranges for the delivery of healthcare services or offers health information management solutions for nearly 4.3 million individuals and families who receive their care through Medicaid, Medicare, and other government-funded programs in 16 states.

The Requirements

To be a good fit for this opportunity you will have:
  • A valid State of Ohio Registered Nurse license.
  • A minimum of 3 years of clinical experience; preferably in ER, home health, critical care, case management, rehab or related specialty.
  • Proficiency with Microsoft Office, strong Excel skills and the ability to learn and utilize new software.
  • Excellent verbal and written communication skills.
  • Advanced organizational and time management skills.
Preferred but not required:
  • A bachelor's degree.
  • 2-plus years of case management or utilization management experience.
  • 2-plus years of facility or nursing home experience.
  • Managed care experience.
  • Knowledge of applicable state, federal and third party regulations and standards.
  • Previous Medicaid and/or government program experience.
  • Case Management Certification.
Your core competencies should include:
  • The ability to establish and maintain a professional rapport with providers, members and internal customers.
  • Excellent multitasking skills and the ability to manage multiple projects and priorities simultaneously.
  • The skill to handle difficult people and situations with diplomacy and tact.
  • Demonstrated dependability and reliability.
  • A desire to continue to enhance your skills/abilities and pursue professional growth opportunities.
You should also have the ability to perform your role in accordance with accrediting and regulatory guidelines, and evidence based practices. You will adhere to the company’s confidentiality, comply with the Health Insurance Portability and Accountability Act (HIPAA), and follow fraud and abuse prevention/detection policies and programs.

The Role

As Complex Case Manager, you will leverage your skills as a Registered Nurse to provide the highest level of care management services to our members with chronic or complex conditions. You'll be responsible for the full cycle of care management services for the health plan membership, which includes proactive identification, assessment, planning, implementation, coordination, monitoring and evaluation.

On a daily basis, you will be making calls to members, following up with providers, receiving incoming calls from members and educating them on the importance of these services, completing general health assessments, building case plans that reflect the needs of the members, completing documentation and discharge plans and much more. Your work will be done via telephone (though a few Complex Case Manager positions do occasional field assessments), and you will maintain an active revolving caseload of approximately 50 cases of varying acuity levels. 

Additionally, you will:
  • Develop and implement a case management plan to address the member’s individual needs as identified in the assessment process in collaboration with the member, caregiver, physician or other appropriate healthcare professionals.
  • Document the case review decisions in Molina’s information system, including referrals to the Medical Director, reasons for recommended denials, appropriate notifications, and any other information relevant to the case.
  • Coordinate health services within the scope of available benefits or refer to appropriate community resources for services that are not covered.
  • Request clinical documentation to support the need for services that require authorization.
  • Participate actively in staff meetings.  Is prepared to discuss cases and collaborate with the multidisciplinary team on case decisions.
  • Participate in the development of criteria or clinical pathways relevant to clinical specialty. Develop monthly or ad hoc reports on case activity and outcome analysis.
  • Establish and maintain a professional rapport with providers, members and internal customers.
  • Handle difficult people and situations with diplomacy and tact.
  • Participate in appropriate conferences to continue to enhance skills/abilities and promote professional growth.
  • Demonstrate dependability and reliability.
  • Comply with required workplace safety standards.
We work 8 to 5, Monday through Friday, so your weekends and holidays are your own.This is a fast paced environment, where you'll be expected to multitask -- talk and type at the same time -- and you'll also need a high level of proficiency with computers. You'll be working with dual computer monitors, so it is essential you are comfortable switching back and forth between the two screens. Our culture is “members first,” so we enjoy team building activities (we have a team huddle meeting every morning to discuss cases and any important issues), an open door policy, and supervisors out on the floor providing immediate availability and full member service.

Note: this description is intended to give you a general overview of the position and is not an exhaustive listing of duties and responsibilities.

Why Molina

Help those who need it most -- Molina Healthcare provides services for members receiving Medicaid or Medicare, as well as other government services. We enjoy working with diverse populations and promoting diversity company-wide. As a Complex Case Manager, you will be serving people who have greater needs, and you can feel proud about the difference you will make in their lives.  

Professional development -- at Molina we support your professional development by providing strong initial training and additional supplemental training as needed. Upon hire, you will attend orientation at our corporate headquarters in Long Beach, California. Post orientation, you'll spend time learning our system and enhancing your phone assessment skills.  Training tools include professionally taught web-based and live classes given by our corporate trainers, standard on the job training such as shadowing team members and being partnered with a mentor, professional conferences and more. Once you're on the floor, you will receive a 2, 4, and 6 month evaluation by a trainer and personal coaching to help you fine-tune your skills.  You will receive all the tools you need to succeed.
 
Best of both worlds -- Molina Healthcare is a publicly traded Fortune 1000 company with approximately 4,200 employees and revenues of $3.6 billion. We’re a large and stable company working in a growth industry. Molina has been active in Ohio for the past five years and we’re expanding our staff to provide an even wider scope of individualized care.   You will enjoy giving a personal touch while being supported by the clout of a large and successful organization.  And, as funding dries up in other programs such as mental health facilities, we continue to thrive.

Career growth -- if you’re hungry and want to grow your career, there will be plenty of opportunities. You might choose to continue to expand your influence in the role (there are levels 1, 2 and Supervisor) or, based upon your skill and performance, you could pursue career paths in other areas. Our continued growth will create opportunities for proven performers.

High performance company -- since our founding in 1980 we have grown from a single health clinic to a multi-state industry leader. We continue to post strong numbers; in 2010 our annual operating income was $105 million, double that of 2009, and net income was 44% higher than the year before. Aggregate membership in 2010 was up 11% over 2009. Our numbers for the first quarter of 2011 showed similar trends.

Excellent compensation -- in addition to a competitive salary, we offer comprehensive benefits that include all you would expect plus some pleasant surprises. For example, we provide two paid days off annually for employees to perform volunteer work at the charity of their choice!

Keys to Success

To excel in this role, first and foremost, you will have an innate desire to help people and provide the best care possible. You'll be working with our highest needs members, who often times have multiple co-morbidities and complex medical issues, so we'll look to you to utilize your clinical nursing experience to develop the best case management plans for each member's specific situation.

You'll also need to be an expert at multitasking, flexible, a team player and a great communicator. You will need the talent to build strong rapport via the telephone and create an atmosphere of trust, confidence and cooperation with the member and those involved with the member’s care.  If you’ve been doing direct patient care, you might find the transition to phone assessment challenging.  Without the face-to-face contact, you will need to fine-tune your skill-set, enhancing your listening abilities and knowing the questions to ask based upon what you’re hearing as well as history.

It's also important to note that the case management function is a new and evolving department within Molina, so we're looking for someone who is proactive, a problem solver and has the ability and drive to identify process improvements and better ways of doing things.

About Molina

Molina Healthcare is a multi-state healthcare organization with flexible-care delivery systems focused exclusively on government-sponsored healthcare programs for low-income families and individuals. Quality is a top priority for Molina, and all eligible Molina health plans are accredited by the National Committee on Quality Assurance, while Molina's 24-hour nurse advice line is accredited by URAC.

Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and the State Children's Health Insurance Program (SCHIP). Molina offers Medicaid plans in California, Florida, Michigan, Missouri, Ohio, New Mexico, Texas, Utah, Washington, and Wisconsin.

Molina also offers Medicare Advantage plans designed to meet the needs of individuals with Medicare or both full Medicaid and Medicare coverage. Molina Medicare plans offer comprehensive quality benefits and programs including access to a large selection of doctors, hospitals, and other healthcare providers at little or no out-of-pocket cost.
Opportunity Snapshot

If you want to challenge yourself professionally while helping those who need a high level of care, this is your opportunity to join a talented and experienced team of Complex Case Managers as we expand our staff at our Columbus, Ohio location.  As a Complex Case Manager you will work on the telephone, providing critical services for members with chronic and complex medical, mental and sometimes even social needs.  You will be part of a multidisciplinary team with other professionals  and will collaborate with both internal and external resources to obtain improved health outcomes.These are the more challenging cases with high risk members usually requiring extensive use of resources throughout multiple segments of the healthcare system and community, and requiring significantly greater coordination.  If you’re looking for the energy of a new expansion initiative, the stability of a strong company with a rich history of success where you can enjoy the work/life balance of traditional business hours, and have the opportunity to feel good about delivering an essential service that can make a viable difference in members’ lives, this role could be your perfect fit.

Since its founding more than 30 years ago, Molina Healthcare has grown into one of the leaders in providing quality healthcare for financially vulnerable individuals and families. Currently, Molina Healthcare arranges for the delivery of healthcare services or offers health information management solutions for nearly 4.3 million individuals and families who receive their care through Medicaid, Medicare, and other government-funded programs in 16 states.

The Requirements

To be a good fit for this opportunity you will have:
  • A valid State of Ohio Registered Nurse license.
  • A minimum of 3 years of clinical experience; preferably in ER, home health, critical care, case management, rehab or related specialty.
  • Proficiency with Microsoft Office, strong Excel skills and the ability to learn and utilize new software.
  • Excellent verbal and written communication skills.
  • Advanced organizational and time management skills.
Preferred but not required:
  • A bachelor's degree.
  • 2-plus years of case management or utilization management experience.
  • 2-plus years of facility or nursing home experience.
  • Managed care experience.
  • Knowledge of applicable state, federal and third party regulations and standards.
  • Previous Medicaid and/or government program experience.
  • Case Management Certification.
Your core competencies should include:
  • The ability to establish and maintain a professional rapport with providers, members and internal customers.
  • Excellent multitasking skills and the ability to manage multiple projects and priorities simultaneously.
  • The skill to handle difficult people and situations with diplomacy and tact.
  • Demonstrated dependability and reliability.
  • A desire to continue to enhance your skills/abilities and pursue professional growth opportunities.
You should also have the ability to perform your role in accordance with accrediting and regulatory guidelines, and evidence based practices. You will adhere to the company’s confidentiality, comply with the Health Insurance Portability and Accountability Act (HIPAA), and follow fraud and abuse prevention/detection policies and programs.

The Role

As Complex Case Manager, you will leverage your skills as a Registered Nurse to provide the highest level of care management services to our members with chronic or complex conditions. You'll be responsible for the full cycle of care management services for the health plan membership, which includes proactive identification, assessment, planning, implementation, coordination, monitoring and evaluation.

On a daily basis, you will be making calls to members, following up with providers, receiving incoming calls from members and educating them on the importance of these services, completing general health assessments, building case plans that reflect the needs of the members, completing documentation and discharge plans and much more. Your work will be done via telephone (though a few Complex Case Manager positions do occasional field assessments), and you will maintain an active revolving caseload of approximately 50 cases of varying acuity levels. 

Additionally, you will:
  • Develop and implement a case management plan to address the member’s individual needs as identified in the assessment process in collaboration with the member, caregiver, physician or other appropriate healthcare professionals.
  • Document the case review decisions in Molina’s information system, including referrals to the Medical Director, reasons for recommended denials, appropriate notifications, and any other information relevant to the case.
  • Coordinate health services within the scope of available benefits or refer to appropriate community resources for services that are not covered.
  • Request clinical documentation to support the need for services that require authorization.
  • Participate actively in staff meetings.  Is prepared to discuss cases and collaborate with the multidisciplinary team on case decisions.
  • Participate in the development of criteria or clinical pathways relevant to clinical specialty. Develop monthly or ad hoc reports on case activity and outcome analysis.
  • Establish and maintain a professional rapport with providers, members and internal customers.
  • Handle difficult people and situations with diplomacy and tact.
  • Participate in appropriate conferences to continue to enhance skills/abilities and promote professional growth.
  • Demonstrate dependability and reliability.
  • Comply with required workplace safety standards.
We work 8 to 5, Monday through Friday, so your weekends and holidays are your own.This is a fast paced environment, where you'll be expected to multitask -- talk and type at the same time -- and you'll also need a high level of proficiency with computers. You'll be working with dual computer monitors, so it is essential you are comfortable switching back and forth between the two screens. Our culture is “members first,” so we enjoy team building activities (we have a team huddle meeting every morning to discuss cases and any important issues), an open door policy, and supervisors out on the floor providing immediate availability and full member service.

Note: this description is intended to give you a general overview of the position and is not an exhaustive listing of duties and responsibilities.

Why Molina

Help those who need it most -- Molina Healthcare provides services for members receiving Medicaid or Medicare, as well as other government services. We enjoy working with diverse populations and promoting diversity company-wide. As a Complex Case Manager, you will be serving people who have greater needs, and you can feel proud about the difference you will make in their lives.  

Professional development -- at Molina we support your professional development by providing strong initial training and additional supplemental training as needed. Upon hire, you will attend orientation at our corporate headquarters in Long Beach, California. Post orientation, you'll spend time learning our system and enhancing your phone assessment skills.  Training tools include professionally taught web-based and live classes given by our corporate trainers, standard on the job training such as shadowing team members and being partnered with a mentor, professional conferences and more. Once you're on the floor, you will receive a 2, 4, and 6 month evaluation by a trainer and personal coaching to help you fine-tune your skills.  You will receive all the tools you need to succeed.
 
Best of both worlds -- Molina Healthcare is a publicly traded Fortune 1000 company with approximately 4,200 employees and revenues of $3.6 billion. We’re a large and stable company working in a growth industry. Molina has been active in Ohio for the past five years and we’re expanding our staff to provide an even wider scope of individualized care.   You will enjoy giving a personal touch while being supported by the clout of a large and successful organization.  And, as funding dries up in other programs such as mental health facilities, we continue to thrive.

Career growth -- if you’re hungry and want to grow your career, there will be plenty of opportunities. You might choose to continue to expand your influence in the role (there are levels 1, 2 and Supervisor) or, based upon your skill and performance, you could pursue career paths in other areas. Our continued growth will create opportunities for proven performers.

High performance company -- since our founding in 1980 we have grown from a single health clinic to a multi-state industry leader. We continue to post strong numbers; in 2010 our annual operating income was $105 million, double that of 2009, and net income was 44% higher than the year before. Aggregate membership in 2010 was up 11% over 2009. Our numbers for the first quarter of 2011 showed similar trends.

Excellent compensation -- in addition to a competitive salary, we offer comprehensive benefits that include all you would expect plus some pleasant surprises. For example, we provide two paid days off annually for employees to perform volunteer work at the charity of their choice!

Keys to Success

To excel in this role, first and foremost, you will have an innate desire to help people and provide the best care possible. You'll be working with our highest needs members, who often times have multiple co-morbidities and complex medical issues, so we'll look to you to utilize your clinical nursing experience to develop the best case management plans for each member's specific situation.

You'll also need to be an expert at multitasking, flexible, a team player and a great communicator. You will need the talent to build strong rapport via the telephone and create an atmosphere of trust, confidence and cooperation with the member and those involved with the member’s care.  If you’ve been doing direct patient care, you might find the transition to phone assessment challenging.  Without the face-to-face contact, you will need to fine-tune your skill-set, enhancing your listening abilities and knowing the questions to ask based upon what you’re hearing as well as history.

It's also important to note that the case management function is a new and evolving department within Molina, so we're looking for someone who is proactive, a problem solver and has the ability and drive to identify process improvements and better ways of doing things.

About Molina

Molina Healthcare is a multi-state healthcare organization with flexible-care delivery systems focused exclusively on government-sponsored healthcare programs for low-income families and individuals. Quality is a top priority for Molina, and all eligible Molina health plans are accredited by the National Committee on Quality Assurance, while Molina's 24-hour nurse advice line is accredited by URAC.

Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and the State Children's Health Insurance Program (SCHIP). Molina offers Medicaid plans in California, Florida, Michigan, Missouri, Ohio, New Mexico, Texas, Utah, Washington, and Wisconsin.

Molina also offers Medicare Advantage plans designed to meet the needs of individuals with Medicare or both full Medicaid and Medicare coverage. Molina Medicare plans offer comprehensive quality benefits and programs including access to a large selection of doctors, hospitals, and other healthcare providers at little or no out-of-pocket cost.
Molina Healthcare Inc. is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
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