Remote RN Case Manager II - Health Plan

Medical Mutual; Cleveland (OH); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

401(k) with company match

Health Savings Account

Medical, dental, vision insurance

Employee Assistance Program

PTO 16 days

Parental leave after 120 days

Job summary

Medical Mutual in Ohio is hiring a Case Manager II to evaluate and support members, families, and physicians in addressing needs and educating on personal health care decisions. The role coordinates care, monitors treatment options, and facilitates communication among the care team.

As an RN with case management experience, you will work to ensure appropriate services and documentation while collaborating with healthcare providers and community resources to improve outcomes.

Qualifications

• 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.

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 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.
• 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.
• Performs other duties as assigned.

Skills

Case management

Nursing expertise

HIPAA compliance

Health coaching

Motivational interviewing

Microsoft Office

Education

RN license (Ohio)

3 years RN + case management

Home health care experience

Tools

Microsoft Office

Windows/Web systems

Job description

Medical Mutual in Ohio is hiring a Case Manager II to evaluate and support members, families, and physicians in addressing needs and educating on personal health care decisions. The role coordinates care, monitors treatment options, and facilitates communication among the care team.

As an RN with case management experience, you will work to ensure appropriate services and documentation while collaborating with healthcare providers and community resources to improve outcomes.