Case Management Nurse

3 days ago

Cincinnati, United States HR ELEMENTS Full time

​This position is for a premier client.

Department:

Medical management

Job Title:

RN - Case Management

Reports to:

Director, Medical Risk Management


Position Overview. This job description provides an overview of the role's general nature and responsibilities. It does not encompass a comprehensive list of all duties, responsibilities, and skills required for individuals in this classification.


As a Case Manager, you will be responsible for overseeing a designated group of employees/employers. This role entails telephonic Case Management (CM) of at-risk individual members, along with management of care plans for high-cost members. This position is onsite, located in Cincinnati.


Key Responsibilities:

  • Respond professionally, promptly, and comprehensively to both internal and external stakeholders.
  • Perform Case Management for members from assigned companies, based on factors such as diagnosis, chronic conditions, and significant medical/pharmacy expenses. Identification of Case Management cases during pre-certification is essential.
  • Adhere to the guidelines set by the Case Management Society of America when documenting interactions and actions.
  • Collaborate with Account Management, Stop Loss, Sales, and Operations teams to meet the needs of employees and employers effectively.
  • Provide backup support to the Utilization Management RN when required.
  • Fulfill any additional responsibilities as assigned.


Essential Qualifications:

  • Minimum of 2 years of experience in Case Management; Case Management certification preferred.
  • Valid RN licensure in either KY, OH or IN
  • Background in clinical practice from a provider's perspective, with diverse clinical exposure, or from the payer side with CM experience.
  • Proficiency in building rapport and establishing connections via phone communication.
  • Strong record-keeping and reporting abilities.
  • Capacity to manage the medical management portfolio for designated employers.
  • Positive attitude and unwavering commitment to delivering exceptional customer service.
  • Flourishes in an environment that embraces continuous improvement and adapts to change.
  • Capable of both functioning as part of a team and advancing as an individual contributor.


Key Fundamentals: 1. Take Care of Our Clients; 2. Deliver Results; 3. Be a Great Teammate; 4. Be Positive and “Bring It”; 5. Listen Generously; 6. Be a Lifelong Learner; 7. Align with Change


StrengthsFinder: Achiever-E; Maximizer-I; Analytical-S; Communication-I; Positivity-R; Adaptability-R; Arranger-E; Learner-S; Developer-R; Restorative-E

​

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