Disease Manager Nurse
Quantum Health - Columbus, OH

This job posting is no longer available on Quantum Health. Find similar jobs: Disease Manager Nurse jobs - Quantum Health jobs

Needed: Caring nurse to ease our growing pains. Quantum Health is an award-winning company that's experiencing explosive growth! As one of the Best Places to Work in Columbus, we're looking for some of th

e best nurses in (or around) Columbus.

Right now, we need a nurse with experience in Disease Management. Beyond that we're looking for a nurse who has a heart of gold and nerves of steel. A Nurse who has a knack for solving problems with a smile and doling out tough love with genuine tenderness.

And if you join us, we hope that you'll work hard. Have fun. Reap the benefits.
  • Steady schedules between 8 am and 10 pm Monday - Friday... No Major Holidays!!!
  • On-site fitness facility
  • Paid maternity and paternity leave for births and adoptions
  • Domestic partner benefits
  • Fun Room with a pool table, ping pong table and air hockey
  • Serenity Room for relaxation and meditation
  • Frequently catered lunches
  • Free beverages, snacks and fresh-popped popcorn ALWAYS
Yes, there's also the "normal" medical/dental/vision insurance, flexible spending accounts, life insurance, 401(k), paid time off and more.

Are you Quantum Health Material? Here is what our ideal candidates look like:

Role and Duties:
  • Promote the mission and core values of Quantum Health
  • Assess all the requests for medical services requiring clinical review against Quantum Health adopted clinical review criteria
  • Provide case management for enrollees identified as having one of the chronic conditions being managed by Quantum.
  • Assess each case presented and utilize the condition specific Care Path to educate
  • Assist patients in planning health goals and provide resources to help them execute goals
  • Document all case management activities specific to interventions for your patients
  • Be a clinical resource for Clinical Services, Patient Services, Case Management, Wellness, Account Coordinators, Account Executives, and Stop Loss Coordinator.
  • Coordinate all services in an effort to provide integrated health services for each patient and provide benefit and health information to each patient so they are able to make informed health decisions.
  • Monitor compliance for each patient
  • Evaluate the response to disease management intervention and report outcomes to Director of Clinical Services
  • Provide group specific data to the Manager of Disease Management for purposes of reporting.
  • Provide aggregate data for groups specific to types of condition, dollar amounts, and level of acuity
  • Provide Case Management to groups not assigned Case Managers
  • Coordinate health management services in an effort to provide integrated health services for each patient and provide benefit and health information to patients, care givers, providers and facilities so they are able to make informed health decisions
Tasks:
  • Identify cases appropriate for Disease Management
  • Organize contact of individuals identified based on acuity
  • Document all contacts in database
  • Document Interventions related to patient, care giver, provider, facility, or client in the database
  • Have working knowledge of all reports and guidelines related to Disease Management
  • Provide monitoring and oversight to non-clinical staff activities and be available to non-clinical staff during CHC business hours
  • Perform Case Management as needed
  • Have knowledge of all reports and guidelines related to Case Management, Utilization Management and pre-certification
  • Provide a patient summary on patient's identified as high acuity or at risk
  • Have knowledge of benefits for groups being managed
  • Have knowledge of where to access benefit information and be able to direct individuals to the information
  • Have working knowledge of Care Paths for all chronic conditions being managed
  • Assist with Wellness activities by identifying needs of groups being managed
  • Assist with health screening activities
  • Have knowledge of how to read Information Analysis Disease Management quarterly report
  • Negotiate for services needed by individual being managed if no clear benefit exists or if the services can only be provided out of network
  • Other duties as assigned
  • Communicate with all staff involved with group when variances occur
  • Have working knowledge of pre-review, initial clinical review, concurrent review and retrospective review and assist these work groups as necessary
  • Facilitate in the discharge planning process by making post service discharge planning calls
Education, Training, and/or professional experience requirement:
  • Licensed as a Registered Nurse with a current license
  • Varied and extensive experience in medical-surgical nursing
  • Minimum of five years clinical experience
  • Certification in Case Management desirable
  • Experience in health management desirable
  • Ability to make decisions that are timely and well thought out that achieve results consistent with business goals and organizational culture
  • Ability to work independently and self directed with limited need for day to day supervision
  • Computer literacy
  • Strong customer service skills
  • Possess excellent verbal and written communication skills
  • Demonstrate cost benefit analysis showing the financial benefit of disease case management
  • Possess excellent time management skills
If you're an exceptional care-giver who's looking to work for a company that will take exceptional care of you, then please apply- Stat!

Quantum Health - 13 months ago - save job - block
Recommended Jobs
Health Coach Consultant
Aetna - New Albany, OH
Aetna - 15 days ago

Senior Specialty Territory Business Manager (...
Bristol-Myers Squibb - Columbus, OH
Bristol-Myers Squibb - 29 days ago

RN Clinical Project Manager in Westerville, O...
UnitedHealth Group - Westerville, OH
UnitedHealth Group - 29 days ago
About this company
15 reviews
Founded in Columbus in 1999, Quantum Health is an award-winning care management and health improvement company serving the healthcare needs...