Case Manager (RN)

Cincinnati, OH

Full Time

Mid Level


Department: Medical Management	Job Title: RN Case Manager	Reports to: Director, Medical Risk Management
Position Overview: This job description provides an overview of the role's general nature and responsibilities. It does not encompass a comprehensive list of all duties, responsibilities, and skills required for individuals in this classification. As a Case Manager, you will be responsible for overseeing a designated group of employees/employers. This role entails telephonic Case Management (CM) of at-risk individual members, along with management of care plans for high-cost members. This position is onsite, located in Cincinnati.
Key Responsibilities: Respond professionally, promptly, and comprehensively to both internal and external stakeholders. Perform Case Management for members from assigned companies, based on factors such as diagnosis, chronic conditions, and significant medical/pharmacy expenses. Identification of Case Management cases during pre-certification is essential. Adhere to the guidelines set by the Case Management Society of America when documenting interactions and actions. Collaborate with Account Management, Stop Loss, Sales, and Operations teams to meet the needs of employees and employers effectively. Provide backup support to the Utilization Management RN when required. Fulfill any additional responsibilities as assigned.
Essential Qualifications: Minimum of 2 years of experience in Case Management; Case Management certification preferred. Valid RN licensure in either KY, OH or IN Background in clinical practice from a provider's perspective, with diverse clinical exposure, or from the payer side with CM experience. Proficiency in building rapport and establishing connections via phone communication. Strong record-keeping and reporting abilities. Capacity to manage the medical management portfolio for designated employers. Positive attitude and unwavering commitment to delivering exceptional customer service. Flourishes in an environment that embraces continuous improvement and adapts to change. Capable of both functioning as part of a team and advancing as an individual contributor. Key Fundamentals: 1. Take Care of Our Clients; 2. Deliver Results; 3. Be a Great Teammate; 4. Be Positive and “Bring It”; 5. Listen Generously; 6. Be a Lifelong Learner; 7. Align with Change StrengthsFinder: Achiever-E; Maximizer-I; Analytical-S; Communication-I; Positivity-R; Adaptability-R; Arranger-E; Learner-S; Developer-R; Restorative-E

Apply for this position

Required*

Apply with Indeed

First Name*

Last Name*

Email Address*

Phone*

Address

Resume*

We've received your resume. Click here to update it.

Attach resume or Paste resume

Attach resume as .pdf, .doc, .docx, .odt, .txt, or .rtf (limit 5MB) or Paste resume

Paste your resume here or Attach resume file

Human Check*

Submit Application