A trusted health insurer for more than 75 years, Medical Mutual is the largest health insurance company headquartered in the state of Ohio and rated one of the most financially secure health insurers in Ohio. As a mutual company, we operate for the benefit of our members without needing to meet the demands of stockholders or Wall Street analysts. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us and help our members achieve their best possible health and quality of life. Medical Mutual has an immediate need for Case Manager to join our Care Management division. The Case Manager will report directly to the Manager, Case Management. Based on business needs, Case Managers can work in Medical Mutual’s Cleveland, Toledo, or Strongsville offices and Case Managers will have future opportunities to work-from-home after successful performance.
The Case Manager serves as a member of the care management team. The Case Manager must practice case management within the scope of their licensure (based on the standards of the discipline). The case manager staff will be expected to assess, plan, implement, coordinate, monitor and evaluate the treatment options of health care services that are clinically appropriate in a timely manner. The Case Manager will assist in meeting the patient’s needs by promoting quality, cost effective outcomes.
The Case Manager will follow the core components of the case management process by being able to coordinate and assure the delivery of service, assess physical as well as psychological factors involved in planning the patients care, evaluation of the benefits and calculate a cost benefit analysis. The Case Manager will be knowledgeable in regards to community resources and apply the case management concepts and standards of care.
• Collaborates with clients, families and providers by assessing patient needs, facilitating and implementing clinical care, planning, education, monitoring and evaluating specific services and advocating health care needs on an individual basis either by phone and/or by onsite visits.
• Utilizes clinical expertise and standards of practice in determining appropriate treatment options.
• Applies knowledge of disease continuums, expected patient outcomes and community services available.
• Applies knowledge of reimbursement practices, cost analysis approaches and provider contract arrangements.
• Bachelors degree (or higher) in a health related field and licensure as a health professional where available or URAC Recognized Certification as a Case Manager, CCM preferred.
• Registered Nurse with current State of Ohio license
• Three (3) years clinical practice experience. Medical case management experience preferred.
• Excellent interpersonal and written communication skills to collaborate/interact effectively and confidentially with internal and external contacts.
• Ability to work independently, yet collaboratively within a team structure.
• Ability to travel to various locations with access to own transportation for business use.
PHYSICAL DEMANDS/WORK ENVIRONMENT:
• Work in a normal office environment
We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse and tobacco testing.
Medical Mutual of Ohio - 9 months ago
Medical Mutual of Ohio is a not-for-profit managed care company that provides health insurance products and related services to some 1.6...