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Home Health Registered Nurse RN Full Time Baylor
33713 St. Petersburg, Florida
Aveanna Healthcare
Posted today
Job Viewed
Job Description
Similar experience is needed.
Position Overview :
The Registered Nurse Baylor is responsible for providing and documenting skilled nursing care in accordance with the developed care plan and physicians’ orders for each individual patient while adhering to confidentiality standards and professional boundaries at all times.
Territory: Pinellas County - Central/South
Schedule: Friday - Monday 4-day and 27 point productivity
Essential Job Functions:
- Develop a plan of care through physician orders, client input, and nursing assessment to include medical interventions and measurable goals and outcomes.
- Educate clients and their family members based on client’s specific needs.
- Properly orient and train primary caregivers to ensure the most optimal functioning level for each client.
- Coordinate the continuum of hands on client care through documentation and timely communication with the client's physician and other caregivers.
- Provide care in patients home using a variety of skills such as phone triage, patient education, observation/assessment, wound care, infusions, catheter care, PICC line dressing changes etc.
Benefits Offerings:
- 401(k) with company match
- Health, dental, vision, life, and pet insurance
- Mileage reimbursement and cell phone allowance
- Generous PTO, sick time, and paid holidays
- Inclusion Day to celebrate what matters to you
- Float Day for extra flexibility and balance
- Up to 8 Hours of Paid Volunteer time yearly
- No-Cost Employee Assistance Program (EAP) - unlimited mental health telephonic counseling sessions, support with identity left, Will preparation and travel assistance
- Robust DEI company program because Inclusion is an Aveanna Core Value
- Tuition discounts and reimbursement
Requirements:
- An active RN License in the state of application
- Valid CPR and valid Drivers License
Preferred:
- Medicare Skilled Nursing experience
- Basic understanding of Oasis
- 1-year RN experience in a health care setting
HHH
As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.
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0
Transition of Care Coach (RN)
33713 Saint Petersburg, Florida
Molina Healthcare
Posted today
Job Viewed
Job Description
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.
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.
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1
Care Review Clinician (RN)
33713 Saint Petersburg, Florida
Molina Healthcare
Posted today
Job Viewed
Job Description
For this position we are seeking a (RN) Registered Nurse who must hold a compact license.
This is a Remote position, home office with internet connectivity of high speed required
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 DESCRIPTION Job SummaryProvides 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 prior authorization/financial responsibility for Molina and its 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: $26.41 - $61.79 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
This is a Remote position, home office with internet connectivity of high speed required
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 DESCRIPTION Job SummaryProvides 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 prior authorization/financial responsibility for Molina and its 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: $26.41 - $61.79 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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2
Lead Engineer, Applications - Edifecs/QConnect - Remote
33713 Saint Petersburg, Florida
Molina Healthcare
Posted today
Job Viewed
Job Description
JOB DESCRIPTION
Job Summary
Designs and builds company specific enterprise application systems and technology expertise across multiple disciplines.
Applies and promotes key principles (e.g., stability, scalability, performance, security, compatibility, re-use), helping ensure a balance between tactical and strategic technology solutions. Considers business problems "end-to-end": including people, process, and technology, both within and outside the enterprise, as part of any design solution. Promotes use of industry and enterprise technology standards. Monitors emerging technologies for potential application within or across the Corporation. Adheres to design and application development standards, methodology and, framework within Architectural compliance and governance.
KNOWLEDGE/SKILLS/ABILITIES
Experience with Edifecs/JavaScript/SQL
Develops software (hands on code development) to meet key business objectives.
Practices and leads SW and applications development methodologies in adherence to SW development standards.
Designs and develops SW applications or systems solving specific business or processing problem (Web or Mobile).
Gathers business requirements and develops conceptual design and technical design for multiple projects concurrently.
Reviews computer system capabilities, work flow and scheduling limitations to determine if requested program or program change is possible within existing system.
Conducts peer review of other developers (internal and contract staff) to ensure standards and quality.
Responsible for quality deliveries for self and application engineers. Participates in build vs. buy evaluation process.
Leads architecture and design discussions in adherence to SW development standards.
Provides design and architectural expertise on application systems / technologies, to both technical teams and business partners.
Responsible to support the application system / service owner for system performance, budgeting, and planning.
Responsible for application system stability and scalability related activities.
Responsible for alignment with project methodologies and change management processes.
Responsible to organize, manage and lead cross-team project tasks and deliverables.
Responsible for designing and building enterprise level application systems.
Responsible for presentations and solutions submitted to technical peer review committees.
Ownership to provide cross-organization teamwork, collaboration, communication, and leadership.
Provides constructive feedback on people, process and technology for continuous improvement.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree in relevant field
Required Experience
3+ years of hands-on technical implementation experience in mid to large IT Enterprise environments.
5-6 years of IT technical experience with IT enterprise infrastructure.
Industry certifications preferred.
Experience with Edifecs/JavaScript/SQL
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.
#PJCorp
#LI-AC1
#HTF
Pay Range: $107,028 - $250,446 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Job Summary
Designs and builds company specific enterprise application systems and technology expertise across multiple disciplines.
Applies and promotes key principles (e.g., stability, scalability, performance, security, compatibility, re-use), helping ensure a balance between tactical and strategic technology solutions. Considers business problems "end-to-end": including people, process, and technology, both within and outside the enterprise, as part of any design solution. Promotes use of industry and enterprise technology standards. Monitors emerging technologies for potential application within or across the Corporation. Adheres to design and application development standards, methodology and, framework within Architectural compliance and governance.
KNOWLEDGE/SKILLS/ABILITIES
Experience with Edifecs/JavaScript/SQL
Develops software (hands on code development) to meet key business objectives.
Practices and leads SW and applications development methodologies in adherence to SW development standards.
Designs and develops SW applications or systems solving specific business or processing problem (Web or Mobile).
Gathers business requirements and develops conceptual design and technical design for multiple projects concurrently.
Reviews computer system capabilities, work flow and scheduling limitations to determine if requested program or program change is possible within existing system.
Conducts peer review of other developers (internal and contract staff) to ensure standards and quality.
Responsible for quality deliveries for self and application engineers. Participates in build vs. buy evaluation process.
Leads architecture and design discussions in adherence to SW development standards.
Provides design and architectural expertise on application systems / technologies, to both technical teams and business partners.
Responsible to support the application system / service owner for system performance, budgeting, and planning.
Responsible for application system stability and scalability related activities.
Responsible for alignment with project methodologies and change management processes.
Responsible to organize, manage and lead cross-team project tasks and deliverables.
Responsible for designing and building enterprise level application systems.
Responsible for presentations and solutions submitted to technical peer review committees.
Ownership to provide cross-organization teamwork, collaboration, communication, and leadership.
Provides constructive feedback on people, process and technology for continuous improvement.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree in relevant field
Required Experience
3+ years of hands-on technical implementation experience in mid to large IT Enterprise environments.
5-6 years of IT technical experience with IT enterprise infrastructure.
Industry certifications preferred.
Experience with Edifecs/JavaScript/SQL
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.
#PJCorp
#LI-AC1
#HTF
Pay Range: $107,028 - $250,446 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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3
LVN Delegation Oversight Nurse Remote
33713 Saint Petersburg, Florida
Molina Healthcare
Posted today
Job Viewed
Job Description
JOB DESCRIPTION
Job Summary
The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other standards and requirements pertaining to delegation agreements. Contributes to overarching strategy to provide quality and cost-effective member care.
This position will support our Corporate Compliance business. The candidate must have an unrestricted LVN licensure. Candidates must be technologically proficient, self-directed, autonomous and experience working from home. Care Management & Waiver Service Auditing experience is highly preferred.
Work hours: Monday - Friday 8:00am – 4:00pm
Remote position
Essential Job Duties
Coordinates, conducts and documents pre-delegation and annual assessments as necessary to comply with state, federal and National Committee for Quality Assurance (NCQA) guidelines, and other applicable requirements.
Distributes audit results letters, follow-up letters, audit tools and annual reporting requirement as needed.
Works with delegation oversight analytics representatives on monitoring performance reports from delegated entities.
Develops corrective action plans (CAPs) when deficiencies are identified, and documents follow-up to completion. Assists with delegation oversight committee meetings.
Works with delegation oversight leadership to develop and maintain delegation assessment tools, policies and reporting templates.
Assists with preparation of delegation summary reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees.
Participates as needed in joint operation committees (JOCs) for delegated groups.
Assists in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid, National Committee for Quality Assurance (NCQA) and/or other regulatory audits as needed.
Required Qualifications
At least 3 years’ experience in health care, including 2 years’ experience in a managed care environment facilitating utilization reviews, or equivalent combination of relevant education and experience.
Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). The license must be active and unrestricted in state of practice.
Knowledge of audit processes and applicable state and federal regulations.
Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet established deadlines.
Ability to collaborate effectively with team members and internal departments.
Strong attention to detail with a focus on maintaining quality in all tasks.
Strong verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) or Certified Professional in Healthcare Quality (CPHQ).
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: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Job Summary
The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other standards and requirements pertaining to delegation agreements. Contributes to overarching strategy to provide quality and cost-effective member care.
This position will support our Corporate Compliance business. The candidate must have an unrestricted LVN licensure. Candidates must be technologically proficient, self-directed, autonomous and experience working from home. Care Management & Waiver Service Auditing experience is highly preferred.
Work hours: Monday - Friday 8:00am – 4:00pm
Remote position
Essential Job Duties
Coordinates, conducts and documents pre-delegation and annual assessments as necessary to comply with state, federal and National Committee for Quality Assurance (NCQA) guidelines, and other applicable requirements.
Distributes audit results letters, follow-up letters, audit tools and annual reporting requirement as needed.
Works with delegation oversight analytics representatives on monitoring performance reports from delegated entities.
Develops corrective action plans (CAPs) when deficiencies are identified, and documents follow-up to completion. Assists with delegation oversight committee meetings.
Works with delegation oversight leadership to develop and maintain delegation assessment tools, policies and reporting templates.
Assists with preparation of delegation summary reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees.
Participates as needed in joint operation committees (JOCs) for delegated groups.
Assists in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid, National Committee for Quality Assurance (NCQA) and/or other regulatory audits as needed.
Required Qualifications
At least 3 years’ experience in health care, including 2 years’ experience in a managed care environment facilitating utilization reviews, or equivalent combination of relevant education and experience.
Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). The license must be active and unrestricted in state of practice.
Knowledge of audit processes and applicable state and federal regulations.
Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet established deadlines.
Ability to collaborate effectively with team members and internal departments.
Strong attention to detail with a focus on maintaining quality in all tasks.
Strong verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) or Certified Professional in Healthcare Quality (CPHQ).
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: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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4
Care Manager - Multiple Openings in FL (RN, LBSW, LLMSW, LMSW)
33713 Saint Petersburg, Florida
Molina Healthcare
Posted today
Job Viewed
Job Description
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 assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments. • Develops and implements care 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. • 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 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. • Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. • 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 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. • 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(s) proficiency. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).
Preferred Qualifications
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
#PJHS
#HTF Pay Range: $24 - $46.81 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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 assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments. • Develops and implements care 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. • 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 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. • Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. • 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 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. • 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(s) proficiency. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).
Preferred Qualifications
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
#PJHS
#HTF Pay Range: $24 - $46.81 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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5
Care Manager - Multiple Openings in FL (RN, LBSW, LLMSW, LMSW)
33713 Saint Petersburg, Florida
Molina Healthcare
Posted today
Job Viewed
Job Description
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 assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments. • Develops and implements care 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. • 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 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. • Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. • 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 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. • 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(s) proficiency. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).
Preferred Qualifications
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
#PJHS
#HTF Pay Range: $24 - $46.81 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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 assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments. • Develops and implements care 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. • 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 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. • Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. • 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 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. • 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(s) proficiency. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).
Preferred Qualifications
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
#PJHS
#HTF Pay Range: $24 - $46.81 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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6
Care Review Clinician (RN)
33713 Saint Petersburg, Florida
Molina Healthcare
Posted today
Job Viewed
Job Description
JOB DESCRIPTION
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 prior authorization/financial responsibility for Molina and its 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 Experience
Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
MULTI STATE / COMPACT LICENSURE preferred
Individual state licensures which are not part of the compact states are required for: CA, NV, IL, and MI
WORK SCHEDULE: Mon - Fri / Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays.
Training will be held Mon - Fri
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.
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 prior authorization/financial responsibility for Molina and its 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 Experience
Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
MULTI STATE / COMPACT LICENSURE preferred
Individual state licensures which are not part of the compact states are required for: CA, NV, IL, and MI
WORK SCHEDULE: Mon - Fri / Sun - Thurs / Tues - Sat shift will rotate with some weekends and holidays.
Training will be held Mon - Fri
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.
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7
Care Review Clinician, PA (RN)
33713 Saint Petersburg, Florida
Molina Healthcare
Posted today
Job Viewed
Job Description
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
Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
Processes requests within required timelines.
Refers appropriate prior authorization requests to Medical Directors.
Requests additional information from members or providers in consistent and efficient manner.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote Molina Care Model
Adheres to UM policies and procedures.
Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.
Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
JOB QUALIFICATIONS
Required Education
Completion of an accredited Registered Nurse (RN).
Required Experience
1-3 years of hospital or medical clinic experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Preferred Experience
Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
MULTI STATE / COMPACT LICENSURE
Individual state licensures which are not part of the compact states are required for: CA, NV, IL, and MI
WORK SCHEDULE: Sun - Thurs / Tues - Sat shift will rotate with some
holidays.
Training will be held Mon - Fri
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 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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
Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members.
Processes requests within required timelines.
Refers appropriate prior authorization requests to Medical Directors.
Requests additional information from members or providers in consistent and efficient manner.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote Molina Care Model
Adheres to UM policies and procedures.
Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.
Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
JOB QUALIFICATIONS
Required Education
Completion of an accredited Registered Nurse (RN).
Required Experience
1-3 years of hospital or medical clinic experience.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Preferred Experience
Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
MULTI STATE / COMPACT LICENSURE
Individual state licensures which are not part of the compact states are required for: CA, NV, IL, and MI
WORK SCHEDULE: Sun - Thurs / Tues - Sat shift will rotate with some
holidays.
Training will be held Mon - Fri
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 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Is this job a match or a miss?
View Now
8
Care Review Clinician (RN)
33713 Saint Petersburg, Florida
Molina Healthcare
Posted today
Job Viewed
Job Description
JOB DESCRIPTION
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 prior authorization/financial responsibility for Molina and its 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.
Preferred Experience
Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
MULTI STATE / COMPACT LICENSURE
Individual state licensures which are not part of the compact states are required for: CA, NV, IL, and MI
WORK SCHEDULE: permanent shift will cover Tues - Sat shift with some holidays.
Training will be held Mon - Fri
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.
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 prior authorization/financial responsibility for Molina and its 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.
Preferred Experience
Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
MULTI STATE / COMPACT LICENSURE
Individual state licensures which are not part of the compact states are required for: CA, NV, IL, and MI
WORK SCHEDULE: permanent shift will cover Tues - Sat shift with some holidays.
Training will be held Mon - Fri
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.
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9