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Nurse Practitioner

Molina Healthcare - Oct 05, 2026
Location-based
Full-time
Salary
Boise, ID
JOB DESCRIPTION Job Summary Provides screening, preventive primary care and medical care services to members - primarily in non-clinical settings where members feel most comfortable, including in-home, community and nursing facilities and “pop up” clinics. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Provides general medical care and care coordination to various and/or specific patient member populations – adult, women’s health, pediatric, and geriatric. • Performs comprehensive evaluations including history and physical exams for gaps in care and preventive assessments. • Addresses both chronic and acute primary care complaints, and demonstrates ability to ascertain medical urgency. • Establishes and documents reasonable medical diagnoses. • Seeks specialty consultation as appropriate. • Orders/performs pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptoms; works within an environment of limited resources and therefore uses diagnostic tests judiciously and appropriately. • Understands when a member's needs are beyond their scope of knowledge and when physician oversight is needed. • Creates and implements a medical plan of care. • Schedules appointments for visits when appropriate. • Provides post-discharge coordination to reduce hospital readmission rates and emergency room utilization. • Performs face-to-face in-person visits in a variety of settings including in-home, skilled nursing facilities, and public locations. • Performs face-to-face visits via alternative modalities based on business need, leadership direction and state regulations. • Orders bulk laboratory orders to target specific member populations. • Performs alternating on-call coverage to triage any urgent lab results and pharmacy inquiries and develops appropriate plans of care. • Participates in community-based “pop up clinics” to build relationships with communities, and address gaps in health care. • Drives up to 120 miles a day on a regular basis to a variety of locations within the assigned region. Drives beyond 120 miles as part of extended mileage may be required on special project days. Special projects may include an overnight hotel stay. • Obtains and maintains cross-state license in other states besides home state based on business need. • Collaborates with fellow nurse practitioners to develop best practices to perform work duties efficiently and effectively. • Actively participates in regional meetings. • May prescribe medications and perform procedures as appropriate. • Performs timely medical records documentation in electronic medical record (EMR) computer system. • On occasion, may be required to walk flights of stairs while carrying up to 50 lbs. of equipment. • Engages in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician to the degree required by state laws. • Local travel required (based upon state/contractual requirements). Required Qualifications • At least 1 year of experience as a nurse practitioner, or equivalent combination of relevant education and experience. • Active and unrestricted national certification from one of the following organizations: American Academy of Nurse Practitioners (AANP) or American Nurses Credentialing Center (ANCC). • Current state-issued license to practice as a Family Nurse Practitioner (FNP). License must be active and unrestricted in state of practice. • Prescriber Drug Enforcement Agency (DEA) license with authority to prescribe per state qualifications. License must be active and unrestricted in state of practice. • Current Basic Life Support (BLS) certification. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently with minimal supervision and demonstrate self-motivation. • Responsive in all forms of communication. • Ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills; ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency, and electronic medical record (EMR) experience. Preferred Qualifications • Experience as a registered nurse or nurse practitioner in a home health, community health or public health setting. • Experience in home health as a licensed clinician, especially in management of chronic conditions. • Experience with underserved populations facing socioeconomic barriers to health care. • Immunization and point of care testing skills. • Bilingual. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $79,608 - $172,483.8 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Care Manager, LTSS (RN)

Molina Healthcare - Oct 05, 2026
Location-based
Full-time
Salary
Worcester, MA
JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports (LTSS)-specific activities. Collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. • Facilitates comprehensive waiver enrollment and disenrollment processes. • Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. • Assesses for medical necessity and authorizes all appropriate waiver services. • Evaluates covered benefits and advises appropriately regarding funding sources. • Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. • Identifies critical incidents and develops prevention plans to assure member health and welfare. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years of experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Ability to operate proactively and demonstrate detail-oriented work. • Demonstrated knowledge of community resources. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. • Ability to work independently, with minimal supervision and demonstrate self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Problem-solving skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. • In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications • Certified Case Manager (CCM). • Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $30.37 - $59.21 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Care Manager (BH Licensed)

Molina Healthcare - Oct 05, 2026
Location-based
Full-time
Salary
Omaha, NE
JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive behavioral health assessments of members per regulated timelines and determines who may qualify for care coordination/case management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. • Develops and implements care plan in collaboration with member, caregiver, physician and/or other appropriate healthcare 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 meetings and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care, provides care coordination and assistance to member to address concerns. • May provide consultation, resources and recommendations to peers as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years health care experience, preferably in behavioral health, or equivalent combination of relevant education and experience. • Licensed behavioral health clinician to include: Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT, Doctor of Psychology (PhD or PsyD) or equivalency based on state contract, regulation, or state board licensing mandate. If licensed, license must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Experience with working with persons with severe and persistent mental health concerns and serious emotional disturbances, to include substance use disorder and foster care. • Knowledge and experience related to whole person care principles, chronic health conditions, and discharge planning coordination. • Data entry skills and previous experience utilizing a clinical platform. • Excellent verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified Case Manager (CCM). • Experience in behavioral health care management. • Field-based care management or home health experience. 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: $25.08 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Care Manager, LTSS (RN)

Molina Healthcare - Oct 05, 2026
Location-based
Salary
Knoxville, IL
JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports (LTSS)-specific activities. Collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. • Facilitates comprehensive waiver enrollment and disenrollment processes. • Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. • Assesses for medical necessity and authorizes all appropriate waiver services. • Evaluates covered benefits and advises appropriately regarding funding sources. • Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. • Identifies critical incidents and develops prevention plans to assure member health and welfare. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years of experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Ability to operate proactively and demonstrate detail-oriented work. • Demonstrated knowledge of community resources. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. • Ability to work independently, with minimal supervision and demonstrate self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Problem-solving skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. • In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications • Certified Case Manager (CCM). • Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $27.73 - $54.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Care Review Clinician (BH Licensed)

Molina Healthcare - Oct 05, 2026
Location-based
Full-time
Salary
JOB DESCRIPTION Job Summary Provides support for member clinical service review processes specific to behavioral health. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations, and 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 - ensuring 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 and presents cases 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 Molina care model. • Adheres to utilization management (UM) policies and procedures. • May work collaboratively with appropriate departments to provide applied behavior analysis (ABA)/behavioral health therapy (BHT) services to Molina members with autism spectrum disorder (ASD) and other related disorders. • May approve requests for BHT by reviewing behavioral assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not limited to: psychological evaluation requests, comprehensive diagnostic evaluations, functional behavioral assessments, and progress reports. • May perform ongoing monitoring of BHT treatment plans to evaluate effectiveness and treatment efficacy. • May provide peer to peer consultation BHT in-network providers to support treatment planning and maximize member progress. • May work collaboratively with ABA providers to ensure best service practices for members. • May create and develops forms, recommendations and guidelines and training for BHT service delivery. • May collaborate and coordinate with behavioral health medical directors, and senior medical directors to ensure proper management of the BHT benefit. Required Qualifications • At least 2 years health care experience, including experience in behavioral health and/or hospital acute care, or equivalent combination of relevant education and experience. • Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT) or equivalent behavioral health licensure. License must be active and unrestricted in state of practice. • May require behavioral analyst experience, and/or board certification/licensure as a behavioral analyst (BCBA and/or LBA). • 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 demonstrate self-motivation. • Responsive in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Recent hospital behavioral health 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: $23.76 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Care Manager (BH Licensed)

Molina Healthcare - Oct 05, 2026
Location-based
Full-time
Salary
Biloxi, MS
JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive behavioral health assessments of members per regulated timelines and determines who may qualify for care coordination/case management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. • Develops and implements care plan in collaboration with member, caregiver, physician and/or other appropriate healthcare 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 meetings and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care, provides care coordination and assistance to member to address concerns. • May provide consultation, resources and recommendations to peers as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years health care experience, preferably in behavioral health, or equivalent combination of relevant education and experience. • Licensed behavioral health clinician to include: Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT, Doctor of Psychology (PhD or PsyD) or equivalency based on state contract, regulation, or state board licensing mandate. If licensed, license must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Experience with working with persons with severe and persistent mental health concerns and serious emotional disturbances, to include substance use disorder and foster care. • Knowledge and experience related to whole person care principles, chronic health conditions, and discharge planning coordination. • Data entry skills and previous experience utilizing a clinical platform. • Excellent verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified Case Manager (CCM). • Experience in behavioral health care management. • Field-based care management or home health experience. 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: $23.76 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Director, Health Plan Quality Program Management & Performance (Texas Health Plan) - REMOTE

Molina Healthcare - Oct 05, 2026
Location-based
Full-time
Salary
Texas
Job Summary Leads and directs team responsible for quality management and quality performance improvement activities. Responsible for overseeing, planning, and implementing new and existing health plan quality improvement activities to maintain compliance with quality program requirements and reporting and monitoring for key quality program activities, and provides support and implementation of National Committee for Quality Assurance (NCQA) accreditation surveys and federal/state quality improvement compliance activities, including compliance with Healthcare Effectiveness Data and Information Set (HEDIS) regulations. Essential Job Duties • Directs team responsible for the implementation of key quality program management strategies, including initiation and management of quality program management activities, surveys, audits, and other activities to meet state, federal and National Committee for Quality Assurance (NCQA) regulatory requirements. • Oversees and leads health plan quality program management and performance activities in compliance with state, federal, and NCQA quality requirements. • Represents the senior leadership team at internal Molina national and regional meetings; serves as subject matter expert for the health plan at state meetings, and actively oversees the completion of effective performance improvement projects. • Collaborates with the national analytics and strategic teams to present and evaluate quality performance management program (QPMP) activities. • Maintains structure and processes for quality program management, including maintenance and modification of quality policies and procedures, management and oversight of committee and workgroup structure, document management, report completion, and tracking of key deliverables. • Prepares written reports and documents that clearly outline the quality program activities and ensure that member and provider feedback is incorporated into quality program management meetings, outcomes from these activities are documented, and continuous quality improvement tools are used to highlight the processes, interventions, and remeasurements are conducted to meet improvement goals. • Maintains ongoing revision of policies and procedures reflective of state, federal and NCQA requirements for all quality program management functions by overseeing the ongoing incorporation and modification of requirements in state-specific policy addendums. • Manages training and education of quality program management and performance staff in alignment with regulatory requirements. • Ensures all quality program management and performance staff are well-versed in the requirements of the quality program and day-to-day work processes to support compliance with state contracts, policies and procedures, and program requirements. • Implements tracking and trending of quality program requirements on an ongoing basis, including operational key performance indicators (KPIs), process reviews, and gap analyses. • Utilizes proven quality improvement methods, such as the plan-do-study-act (PDSA) cycle, to facilitate individual, team, and organizational process improvement. • Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of quality/department-specific goals • Same-day out-of-office travel approximately 0-50% of the time may be required, depending on health plan/state-specific needs. • Multi-day out of town overnight travel approximately 0-20% of the time may be required, depending upon health plan/state-specific needs. Required Qualifications • At least 8 years of experience in health care, with at least 5 years of experience in health plan quality improvement, or equivalent combination of relevant education and experience. • At least 3 years management/leadership experience. • Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. • Advanced knowledge and understanding of HEDIS/NCQA. • Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience. • Healthcare Effectiveness Data and Information Set (HEDIS) reporting/collection experience. • Experience with government-sponsored programs (Medicaid, Medicare, Marketplace). • State quality improvement (QI) experience. • Solid business writing experience. • Strong strategic-thinking skills. • Strong proficiency with data analysis, manipulation, interpretation, reporting and data-driven decision-making. • Critical-thinking, problem-solving and analytical skills. • Attention to detail and organizational skills. • Ability to implement process improvement initiatives and drive change. • Ability to work independently in a fast-paced, deadline-driven environment. • Ability to work in a cross-functional highly matrixed organization. • Project management experience. • Excellent verbal and written communication skills. • Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs. Preferred Qualifications • Demonstrated experience in leading significant cross-functional work. • Provider credentialing and subcontractor monitoring experience. • Certified Professional in Health Quality (CPHQ). • Certified HEDIS Compliance Auditor (CHCA). • Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice. NCQA standard – understanding, knowledge and experience interpreting the standards and applying. NCQA accreditation audit experience and knowledge. Experience leading audits to ensure compliance with state contract and regulatory requirements. EPSDT and/or Texas Health Steps knowledge and experience. Performance Improvement Projects experience. 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: $97,299 - $189,732 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Transition of Care Coach (RN) East St Louis, IL

Molina Healthcare - Oct 05, 2026
Location-based
Full-time
Salary
East Saint Louis, IL
JOB DESCRIPTION Job Summary Provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from hospital admission to all other settings. Strives to ensure that best possible services are available to members at time of hospital discharge, and focuses on goal to reduce member readmissions. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Follows member throughout a 30 day program that starts at hospital admission and continues oversight through transitions from acute setting to all other settings, including nursing facility placement/private home, with the goal of reduced readmissions. • Ensures safe and appropriate transitions by collaborating with the hospital discharge planner, as well as collaborating with hospitalists, outpatient providers, facility staff, and family/support network. • Ensures member transitions to setting with adequate caregiving and functional support, as well as medical and medication oversight support. • Works with participating ancillary providers, public agencies or other service providers to make sure necessary services and equipment are in place for safe transition. • Conducts face-to-face visits of all members while in the hospital and, home visits high-risk members post-discharge as needed. • Coordinates care and reassesses member needs using the Coleman Care Transition model post-discharge. • Educates and supports member focusing on seven primary areas (Transition of Care 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 (ICT) and collaboration. • Provides consultation, recommendations and education as appropriate to non-behavioral health care managers. • 40-50% local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, with at least 1 year of experience in hospital discharge planning, care management or behavioral health setting, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Knowledge of or experience using the Care Transitions Intervention (CTI) or similar model. • Background in discharge planning and/or home health. • Demonstrated knowledge of community resources. • Proactive and detail-oriented. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and demonstrate self-motivation. • Responsive in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Excellent verbal and written communication skills. • Microsoft Office suite/other applicable software program(s) proficiency. Preferred Qualifications • Transitions of care sub-specialty certification and/or Certified Case Manager (CCM). • Hospital discharge planning or home health experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $27.73 - $54.06 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Care Manager, LTSS (RN)

Molina Healthcare - Oct 05, 2026
Location-based
Full-time
Salary
Madison, WI
***Remote with travel throughout Dane, Dodge, Jefferson, & Rock Counties, WI for member visits*** JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports (LTSS)-specific activities. Collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. • Facilitates comprehensive waiver enrollment and disenrollment processes. • Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. • Assesses for medical necessity and authorizes all appropriate waiver services. • Evaluates covered benefits and advises appropriately regarding funding sources. • Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. • Identifies critical incidents and develops prevention plans to assure member health and welfare. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years of experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Ability to operate proactively and demonstrate detail-oriented work. • Demonstrated knowledge of community resources. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. • Ability to work independently, with minimal supervision and demonstrate self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Problem-solving skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. • In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications • Certified Case Manager (CCM). • Experience working with populations that receive waiver services. #PJHS #LI-AC1 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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Care Manager, LTSS (RN)

Molina Healthcare - Oct 05, 2026
Location-based
Full-time
Salary
Trempealeau, WI
***Remote with travle throughout La Crosse, Monroe, & Trempealeau Counties, WI for member visits*** JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports (LTSS)-specific activities. Collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. • Facilitates comprehensive waiver enrollment and disenrollment processes. • Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. • Assesses for medical necessity and authorizes all appropriate waiver services. • Evaluates covered benefits and advises appropriately regarding funding sources. • Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. • Identifies critical incidents and develops prevention plans to assure member health and welfare. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years of experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Ability to operate proactively and demonstrate detail-oriented work. • Demonstrated knowledge of community resources. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. • Ability to work independently, with minimal supervision and demonstrate self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Problem-solving skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. • In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications • Certified Case Manager (CCM). • Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $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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