RN Advantage Case Manager East - Case Management - Full Time - Days

    Cleveland, OH
    Similar jobs pay $25.60 - $32.38

    Job Description

    Thank you for inquiring about a position with Paramount. We are a NCQA accredited managed care plan, which is part of ProMedica's integrated healthcare system with offices in Maumee, Columbus, Cleveland, and Cincinnati. Paramount provides health insurance coverage for Medicare, Medicaid, and Commercial members. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.

    Our mission is to improve your health and well-being. So we're committed to your wellness with various initiatives, such as preventive services, online knowledge, health risk assessments, our Steps2Health disease management programs, health fairs, and more.

    ProMedica Paramount in Cleveland, Ohio is recruiting for RN Case Managers. The case manager assesses, plans, implements, coordinates, monitors and evaluates the ongoing care of a specific caseload through the Continuum of Care; collaborates with members of the health care team, members and their families to ensure effective, efficient and appropriate care during the entire episode of illness and for post-discharge services. Monitors utilization and evaluates outcomes. This position reports directly to theCase Management Manager. No positions report to this position.


    1. Assessment: Assess identified "Advantage" members to determine case management needs by trigger diagnoses, disease management needs, high dollar cost, complex medical conditions, emergency room utilization, readmissions or excessive length of stay. Conduct a comprehensive health care plan review that includes member contact and PCP contact. Assess the member's functional status, decision-making ability, and psycho-social needs. Enter identified "Advantage" members into Advantage Case Management with PCP and member consultation.
    2. Planning: Plan a flexible care plan developed in conjunction with the member, PCP, health care team and other persons involved in the member's care. The plan should address the member's health care needs identified in the assessment process. Community resources, psycho-social needs and end of life care are included in the plan of care.
    3. Implementation and Coordination: Coordinate current treatment plans with the PCP and maximize benefits through in-Plan provider utilization. Utilize cost benefit analysis. Ensure communication of goals with all health care team members. Coordinate psychological care with in-Plan providers and with Behavioral Health Case Management coordinators.
    4. Monitoring and Evaluation: Review the member's progress and conduct periodic reassessment of the care plan based on changing member needs. Evaluate, initiate and coordinate case management members' potential discharge planning and follow-up needs. Evaluate and manage resources and optimize reimbursement to ensure that members receive the most appropriate medical care in the most cost-effective setting.
    5. Communication: Provide members and families with ongoing, current information and support to enhance satisfaction throughout the continuum of care. Facilitate communication among members of the health care team. Ensure privacy and confidentiality under current federal regulations. Adherence to ethical, legal and accreditation/regulatory standards.
    6. Documentation: Documentation follows current Paramount procedures. Has good knowledge of Advantage coverage, exclusions and Medicaid guidelines for appropriate system documentation. Demonstrates good skills in the required paper and electronic systems.
    7. General: Act as a member advocate, maintain and ensure member privacy and confidentiality, adhere to ethical, legal and accreditation/regulatory standards for all Case Management activities/interventions. While most case management interaction is telephonic through out the case management process as defined above, multidisciplinary face to face meetings with members and providers may be beneficial and necessary to effectively coordinate the member's treatment plan of care. Must have the ability to travel and make face to face visits with members.
    8. Perform other duties as directed.

    Job Requirements


    Current Ohio and Michigan Registered Nurse license required or current Ohio and Michigan license for LSW, LISW, PhD and/or other equivalent and appropriate licensure.
    Valid drivers license with proof of auto insurance.
    Certification in Case Management strongly preferred. If not certified, willingness to obtain certification when eligible and appropriate as deemed by manager.
    Minimum 1 year experience as a Case Management Coordinator or as a Utilization Management Coordinator. Excellent communication (oral and written) and organizational skills required. Demonstrated ability to plan, coordinate and organize multiple priorities.
    Demonstrated PC skills, including word processing/spreadsheet/data base and graphics applications strongly preferred. Experience with electronic health record documentation.
    Ability to move between company work stations and departments; ability to communicate on telephones and operate general office equipment, including computers.

    ProMedicais a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 56,000 employees, 13 hospitals, 2,100+ physicians and advanced practice providers with privileges, 900+ healthcare providers employed by ProMedica Physicians, a health plan, and nearly 400 assisted living facilities, skilled nursing and rehabilitation centers, memory care communities, outpatient rehabilitation clinics, and hospice and home health care agencies. Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. For more information about ProMedica, please visit www.promedica.org/aboutus.

    Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.

    Equal Opportunity Employer/Drug-Free Workplace

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    Posting ID: 556730259Posted: 2020-05-22