Case Manager II

Superior Dental Care, Inc.; Cleveland, Northern (OH, KY); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

401(k) with company match

PTO and parental leave

Job summary

Medical Mutual is seeking a nurse case manager for a remote-based role focused on guiding members, families, and physicians through care options and barriers. The position emphasizes coordinated care, documentation, and collaboration within the health plan framework.

The ideal candidate has an Ohio RN license with 3+ years of clinical/case management experience, preferably in health insurance, and may hold CCM certification. Strong communication and HIPAA knowledge are essential for success.

Qualifications

• RN license in Ohio; CCM or similar certification preferred.
• Minimum 3 years as an RN with clinical and case management experience; health insurance experience preferred.
• Home health care experience is a plus.
• Experience in the health insurance industry is preferred.
• Knowledge of HIPAA and regulatory guidelines; strong communication skills.

Responsibilities

• Manage complex health care cases via phone, email, and video.
• Verify eligibility, benefits, enrollment history, clinical history, and demographics.
• Educate members and families on care options and barriers to care.
• Coordinate services with community resources and support groups.
• Document accurately per policies and procedures; train junior staff as needed.

Skills

Health coaching

Motivational interviewing

Behavioral change

HIPAA

Care coordination

Education

RN license (Ohio)

CCM or equivalent

Motivational Interviewing cert (preferred)

Tools

Microsoft Office

Job description

**This is a remote-based role, and we are currently seeking candidates located in Ohio.**

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Job Summary:

Under limited supervision, evaluates and provides support to members, their families, and physicians in addressing member needs. Educates members and families to make informed personal health care decisions and determines the most effective treatment options. Facilitates communication between member, physician, and community.

Responsibilities:

• Independently manages complex health care cases by multiple means such as phone, email, and video conferencing. Verifies eligibility, benefits, enrollment history, clinical history, and demographics. Assesses patient needs by gathering information from the member, family, provider, and other stakeholders to monitor and evaluate for medical appropriateness and quality of care. Educates members and assists them in removing barriers and with various treatment options.
• Facilitates and implements interventions based on agreed upon care treatment plan developed in collaboration with all participants in the members healthcare team. Coordinates services with community resources and support groups with members.
• Keeps up to date on and maintains appropriate documentation within Company and regulatory guidelines, policies, and practices.
• If assigned to Preceptor/Trainer task: Orients, trains, and provides guidance to more junior or less experienced staff. Supports implementation of new procedures, processes, or clinical systems.
• Performs other duties as assigned.

Qualifications:

Education and Experience:

• Graduate of a registered nursing program approved by the Ohio State Nursing Board.
• 3 years as a Registered Nurse with a combination of clinical and case management experience, preferably in the health insurance industry.
• Home health care experience is a plus.

Professional Certification(s):

• Registered Nurse with current State of Ohio or Multistate unrestricted license.
• Certified Case Manager (CCM) or other industry recognized certification preferred.
• Certification in Motivational Interviewing preferred.

Technical Skills and Knowledge:

• In depth knowledge of health insurance benefits, health plans, and industry trends, and the ability to apply knowledge to achieve positive outcomes.
• Strong knowledge of behavioral change techniques and health coaching (ex. readiness to change and motivational interviewing)
• Knowledge of, and the ability to apply fundamental concepts related to HIPAA compliance and related regulations.
• Knowledge of disease continuums, expected patient outcomes and community services available.
• Intermediate proficiency navigating windows and web based systems and basic Microsoft Office skills.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

#LI-CS1 #LI-REMOTE

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.