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RN Case Manager, East- Paramount -

Youngstown, Ohio; Maumee, Ohio; Toledo, Ohio; Cleveland, Ohio; Columbus, Ohio

Overview

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.

  • Full Time
  • Level: Mid
  • Travel: No
  • Glassdoor Reviews and Company Rating

Success Profile

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
Traits are on a scale of 0 to 10

Additional success profiles:

  • Detail oriented,
  • Flexible,
  • Helpful,
  • Patient,
  • Responsible,
  • Sincere,
  • Understanding

Benefits

  • Professional
    Growth

  • Retirement &
    Savings Plan

  • Innovative
    Training Programs

  • Tuition Assistance

  • Career Stability

  • Comprehensive Health
    Coverage

Job Requirements

At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.

 

Position Summary

Responsible for assessing, planning, coordinating, implementing and evaluating care for selected patient/client populations attained through telephonic and or field case management practices completed in an office environment. Complies with nationally recognized case management guidelines and standards, and operates within the scope of practice for Registered Nurse licensure. 

 

Professional Competencies

  • Completes an initial assessment that assesses current medical history, current diagnosis, past medical history, current treatments and social history.
  • Completes an initial plan of care in collaboration with the patient and appropriate members of the health care team and family.
  • Identifies short-term goals, long-term goals, specific referrals with timeframes for follow-up and evaluation, community resources to be utilized, case closure criteria and anticipated case outcomes.
  • Assures that the goals and plan are appropriate for the employer’s benefit plan or the laws and rules of the Ohio BWC, if applicable.
  • Responsible for performing the core components of utilization management activities. Obtains all necessary information and medical documentation while utilizing evidence-based guidelines to support authorization of treatment interventions. Obtains physician input as appropriate to assist in authorization decisions.
  • Coordinates and implements patient services as part of a multidisciplinary team.  Refers patients for vocational rehabilitation as appropriate.  Coordinates psychosocial intervention as needed.
  • Communicates and acts as a liaison with all parties and providers involved with the plan of care to maintain continuity of care.
  • Monitors and evaluates plan effectiveness and outcomes.
  • Negotiates pricing for services as needed.  Channels to preferred provider networks when appropriate.
  • Provides accurate, consistent documentation of interactions with patient/family, employers, multidisciplinary team members, attorneys, TPAs, etc.
  • Maintains patient/client confidentiality.
  • Provides excellent customer service to internal and external customers.
  • Travels to meet with clients at their facilities to conduct claims review meetings, presentations, and is available for conference calls with clients. May provide community based health services. 

 

Related Accountabilities

  • Participates in department and company meetings, training, employee development programs, and trains new staff members as needed (25%).
  • Contributes to quality and safety management activities and customer service initiatives (35%).
  • Participates/performs in other departmental activities/related duties as assigned (40%).

  • Graduate of an accredited Registered Nurse school of nursing with current unrestricted Ohio Registered Nurse Licensure required.
  • Bachelor Degree preferred.
  • Minimum of 2 years general clinical experience required and previous utilization management and/or case management experience preferred. 
  • Will be required to obtain CCM certification (or other URAC acceptable credential) within 4 years of hire to the position or maintain current CCM certification.
  • Basic computer knowledge required.

 

ProMedica is a mission-based, not-for-profit integrated healthcare organization 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 employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace

Job ID 60280 Date posted 09/27/2021
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Julie Luffy head-shot and quote

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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