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SW Advantage Case Manager, East - Behavioral Health- Paramount - Full Time - Days

Cleveland, 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

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. 

 

Basic Purpose

Assesses, plans, implements, coordinates, monitors and evaluates the ongoing care of a specific caseload of members with behavioral health conditions 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.  No positions report to this position.

 

Primary Duties

  • Assessment:  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.
  • Planning:  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.
  • Implementation and Coordination: 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. 
  • 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.  
  • 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. 
  • Documentation:   Documentation follows current Paramount   procedures.  Has good knowledge of Advantage/Medicaid coverage, exclusions and Medicaid guidelines for appropriate system documentation.  Demonstrates good skills in the required paper and electronic systems.
  • 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. Case management interaction is telephonic throughout the case management process as defined above. In addition, multidisciplinary face to face meetings with members and providers are 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.  
  • Perform other duties as directed.
     

  • Current Ohio and Michigan Registered Nurse license required or current Ohio and Michigan license for LSW, LISW, LPC, PhD and/or other equivalent and appropriate licensure.
  • Valid driver’s license with proof of auto insurance
  • Must have the ability to travel and make face-to-face visits with members. Visits may take place in a variety of settings; including but not limited to member home/provider office.  
  • 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 in the mental health or substance use disorder field.  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.

 

 

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 59115 Date posted 08/19/2021
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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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