Supervisor, Case Management

Medical Mutual•Cleveland, OH

7d•Hybrid

About The Position

Medical Mutual employees must submit their applications through MySource. This is a hybrid-remote role based out of the Brooklyn, OH office, with the Supervisor, Case Management expected to work onsite on four designated in-office days each week. 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: Organizes and manages the workflow of all activities and the day-to-day operations in case management. Performs supervisory functions including selection, coaching, and performance appraisal of case management staff. Participates in process improvement and quality team initiatives.

Requirements

Graduate of a registered nursing program approved by the Ohio State Nursing Board.
7 years progressive experience as a Case Manager in health insurance or equivalent experience as an RN in clinical practice, utilization review, or case management.
Relevant experience leading teams or projects (formally or informally).
Registered Nurse with current State of Ohio unrestricted license.
Intermediate Microsoft Office skills and proficiency navigating windows and web-based systems.
Knowledge of medical terminology/coding and managed care processes.
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.
Strong knowledge of clinical claim management including ICD 10, CPT and HCPCS code.
Strong knowledge of health insurance benefits and network plan designs.
Knowledge of care delivery systems and continuum of acute through post-acute care
Ability to manage workload and coach staff.

Nice To Haves

Bachelor’s Degree preferred.
Certified Case Manager (CCM) or other industry recognized certification preferred (if not certified, required to obtain within 3 years of hire.)

Responsibilities

Oversees the operations of care management staff in their day to day functions within a department.
Works to ensure that staff maintain clinical competencies that enable them to effectively achieve case management outcomes.
Monitors and evaluates the effectiveness of programs and procedures and recommends and/or implements changes as indicated.
Reviews production and quality data to ensure accuracy and consistent application of policies and procedures.
Participates in recruitment, selection, hiring, orientation, counseling and evaluation of staff.
Serves as a resource for other departments and external customers in resolving complex issues related to department functions.
Performs other duties as assigned.

Benefits

Laptop, monitors, keyboard, mouse and headset provided.
Access to on-site fitness centers or gym membership reimbursement.
On-site cafeteria at Brooklyn, OH headquarters.
Discounts at many places in and around town.
Opportunity to earn cash rewards for shopping with 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.
Company holidays.
Up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
Parental leave for eligible employees who become parents through maternity, paternity or adoption (after 120 days of service).
Career development programs and classes.
Mentoring and coaching.
Tuition reimbursement up to $5,250 per year.
Diverse, inclusive and welcoming culture with Business Resource Groups.