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.
- 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.
- Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor's Degree preferred.
- 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.
- Registered Nurse with current State of Ohio unrestricted license. Multiple state licensure preferred and may be required.
- Certified Case Manager (CCM) or other industry recognized certification preferred (required within 3 years of hire for commercial case management)
- Certification in Motivational Interviewing preferred.
- 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.
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:
A Great Place to Work:
- Top Workplace in Northeast Ohio. Year after year we've received this recognition!
- On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
- On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
- Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
- Business casual attire
Excellent Benefits and Compensation:
- Competitive compensation plans
- Employee bonus program
- 401(k) with company match and an additional company contribution
- Excellent medical, dental, vision, and disability insurance
An Investment in You:
- Career development programs and classes
- Mentoring and coaching to help you advance
- Education reimbursement up to $5K per year
About Medical Mutual:
We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!
At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
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