Case Manager-Care Management

The MetroHealth System (Cleveland, OH); Cleveland (OH); On-site; USD 80,000 - 105,000; Full time

Job summary

The MetroHealth System is seeking an experienced RN Case Manager to coordinate care across the continuum, collaborating with payers, external case managers, and the interdisciplinary team. You will assess patients for case management interventions and negotiate benefits and care plans among patient, family, team, and payer.

The role requires a BSN with an Ohio RN license and at least three years of inpatient or home-care experience, plus strong communication and organizational skills.

Qualifications

• Bachelor’s Degree in Nursing (BSN) from an accredited institution.
• Current Registered Nurse (RN) license in Ohio.
• Three years of hospital inpatient care or home care experience.
• Ability to work independently and in interdisciplinary teams.
• Excellent verbal and written communication skills.
• Strong organizational skills.
• Ability to prioritize tasks.
• Good clinical reasoning skills.
• Proficiency with computers and software.
• Demonstrated ongoing professional development in nursing/case management in past 12 months.
• Master’s Degree in Nursing (MSN) preferred.
• Case Management certification preferred.
• Two years’ experience with case management, discharge planning, home health, or third-party reimbursement preferred.
• Experience in clinical environments preferred.
• Physical ability to sit/stand, see clearly, hear, and work around exposure to pathogens and chemicals.

Responsibilities

• Interacts with payers, external case managers, employers, post-acute providers, and the care team throughout the case management process.
• Assesses patients for potential case management intervention.
• Negotiates benefits and care plans among patient, team, family, and payer.
• Monitors the effectiveness of the care plan and payer satisfaction.
• Upholds The MetroHealth System’s mission, vision, and customer service standards.

Skills

Case management

Interdisciplinary teamwork

Communication skills

Clinical reasoning

Organizational skills

Computer proficiency

Continuing education

Education

Bachelor's Degree in Nursing (BSN)

OH RN license

MSN (preferred)

Tools

Electronic Health Records (EHR)

Job description

Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 80.00 Shift: 7:30AM-4:00PM

The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County’s safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.

Summary

Interacts with third party payers, external case managers, employers, post-acute service providers, and the interdisciplinary team throughout the case management process. Assesses patients for potential case management intervention. Negotiates benefits and care plans between patient, team, family, and payer. Monitors the effectiveness of the care plan and customer/third party payer satisfaction. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.

Qualifications

• Required: Bachelor’s Degree in Nursing (BSN) from an accredited institution.
• Required: Current Registered Nurse (RN) licensee for the State of Ohio.
• Required: Three years of hospital in-patient care or home care experience.
• Required: Able to work independently and as a member of interdisciplinary teams.
• Required: Effective interdisciplinary, verbal, and written communication skills.
• Required: Good organizational skills.
• Required: Ability to prioritize tasks.
• Required: Good clinical reasoning skills.
• Required: Demonstrates proficiency with computers and computer software.
• Required: Proven history of on-going professional development in a nursing specialty and/or case management within the past 12 months via either current continuing education certificates or a letter from an accredited academic program.
• Preferred: Master’s Degree in Nursing (MSN) from an accredited institution.
• Preferred: Certification in Case Management from a recognized issuing organization.
• Preferred: Two years of experience with case management, discharge planning, home-health, and/or third party reimbursement systems.
• Preferred: Experience in clinical environments.
• Physical Requirements:
• May sit, stand, stoop, bend, and ambulate intermittently during the day.
• May need to sit or stand for extended periods.
• See in the normal visual range with or without correction.
• Hear in the normal audio range with or without correction.
• Requires some exposure to communicable diseases or body fluids.
• Requires some exposure to chemicals and cleaning products.