Case Manager II

Medical Mutual•Cleveland, OH

8d•Remote

About The Position

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. 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.

Requirements

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.
Registered Nurse with current State of Ohio or Multistate unrestricted license.
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.

Nice To Haves

Home health care experience is a plus.
Certified Case Manager (CCM) or other industry recognized certification preferred.
Certification in Motivational Interviewing preferred.

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.

Benefits

We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
On-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available.
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.
Business casual attire, including jeans.
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.
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.
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.