RN / Registered Nurse - Advantage Case Manager - Case Management - Paramount - Full Time - Days
Cincinnati, Ohio; Cleveland, Ohio
The Registered Nurse provides nursing care to individuals and groups which require specialized knowledge, judgment, and skill derived from the principles of biological, physical, behavioral, social, spiritual/cultural, and nursing sciences. The Registered Nurse functions within the full scope of nursing practice as noted by the Board of Nursing of their designated state for which they are practicing in addition to compliance with any of the hospitals accrediting bodies.
Who is the ideal Promedica employee? We're looking for people to join our team who are motivated by making an impact and doing meaningful work.
- Responsible 10
- Critical thinker 9
- Compassionate 9
- Communicator 9
- Adaptable 9
- Multi-tasker 8
Additional success profiles:
- Detail oriented,
For more than 30 years, Paramount, ProMedica’s health plan, has offered health insurance products across six Midwest states. Paramount is an Ohio-based health insurance company, headquartered in Maumee. Our team of more than 800 employees is dedicated to serving our health plan members.
Paramount offers Medicare Advantage, Medicaid managed care and Marketplace Exchange health plans for individuals and families. We maintain accreditation by the National Committee for Quality Assurance (NCQA) for our HMO, Medicare Advantage and Medicaid products.
We also offer a full complement of insurance products for employers of any size, including medical, dental, vision and workers’ compensation as well as vocational rehabilitation, life-care planning and wellness.
As a part of ProMedica, we are driven by our Mission to improve your health and well-being. ProMedica is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. At Paramount, we strive to provide an exceptional experience to every member. For more information about Paramount, please visit our website.
Paramount is recruiting for RN Case Managers to join the Behavioral Health Team. 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. Further, this position monitors utilization and evaluates outcomes. This position reports directly to the Advantage Case Management Manager. No positions report to this position.
- Assess identified “Advantage” members to determine case management needs by trigger diagnoses, disease management needs, high dollar cost, complex behavioral health conditions, emergency room utilization, readmissions or excessive length of stay. Conduct a comprehensive health care plan review that includes member contact and provider contact. Assess the member's functional status, decision-making ability, and psycho-social needs. Enter identified “Advantage” members into Advantage Case Management Program with provider and member consultation and member consent.
- Plan a flexible care plan developed in conjunction with the member, provider, 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.
- Coordinate current treatment plans with the primary provider and maximize benefits through in-Plan provider utilization. Utilize cost benefit analysis. Ensure communication of goals with all health care team members. Coordinate physical health care with in-Plan providers and with Medical Case Management coordinators.
- 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.
- Current Ohio Registered Nurse or LSW license required.
- Valid driver license.
- 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 with Behavioral Health Patients preferred.
- Minimum 1 year experience as a Behavioral Health Case Management Coordinator or as a Behavioral Health Utilization Management Coordinator preferred
- Minimum 1 year home care with Behavioral Health Patients preferred.
- Excellent communication (oral and written) and organizational skills required. Demonstrated ability to plan, coordinate and organize multiple priorities.
- Demonstrated PC skills, 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.
ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact firstname.lastname@example.org
Equal Opportunity Employer/Drug-Free Workplace
I joined ProMedica in 2014, right after I finished nursing school. I’ve always wanted to become a nurse, I enjoy the feeling of making people feel safe and caring for them. Nursing is about being there for someone when they feel alone and holding their hand when they are scared. It was easy to choose PROMEDICA due to the residency program that I heard wonderful things about. The residency helped guide me into becoming a confident nurse. I started on the orthopedic floor where I have learned so much from my wonderful work family! I’ve done many different things within the hospital setting, such as becoming an EPIC superuser where I even went in Coldwater to help with their go-live. I was part of the skin team, served on a Nursing grand rounds forum. In July I was crossed trained to the Adult ICU, it was something I thought would be a wonderful experience, I’ve meet a great group of people that I enjoyed training and working with when needed. ~Julie
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