Sr. High Cost Case Manager - RN
Catholic Health Partners (CHP) is the largest health system in Ohio and one of the largest nonprofit health systems in America. CHP has been recognized as one of the “2012 Best Employers in Ohio” and named a “2011 Best Place to Work” by the Cincinnati Business Courier. Thomson Reuters has also named CHP as one of the top 10 U.S. health systems, based on our hospitals’ clinical performance.
This is a telephonic Case Manager position working with the top High Cost Claimants of our customers. Your role will be to provide ongoing management of a client’s chronic/ complex needs, multiple co morbidities, or complicated psychosocial factors which may interfere with the delivery of their care. We are looking for nurses who want to proactively engage in these types of cases to help identify alternate approaches to the management of cost, quality and outcomes for the clients.
It is expected that all of the Principal duties and Responsibilities identified below will be performed in a manner that reflects the values of Catholic Health Partners, which are: Compassion, Excellence, Human Dignity, Justice, Sacredness of Life and Service.
Duties and Responsibilities:
Use of UM/CM processes to provide identification of chronic/complex high cost use of care by the 1-2% of clients using the following high cost services which may include:
- Chronic High cost drug utilization
- Chronic Medical conditions
- Knowledge of:
- Patient assessment
- Claim review
- Treatment planning
- Redirection to in network facilities and physicians
- Identification of alternative service opportunities
- Benefit plan coordination
- Coordination of physician, patient, and family communication
- Documentation and reporting
- Patient outcomes evaluation
- Patient and provider satisfaction
- Consulting with the Medical Director
- Position Criteria
- Current non-restricted Ohio RN licensure
- Insurance or hospital based Case Manager experience a plus
- Claim review experience a plus
- BSN degree or certification as a case manager, or Ohio RN licensure and 3 years clinical practice experience and two years case management experience.
- Effective oral and written communication skills, communicates information correctly
- Self-directed, self-starter
- Understanding of systems and change process
- Tact and diplomacy
- Personal computer skills
- Highly organized and detail oriented
- Accepts responsibility and follow through on projects and activities
- Ability to analyze and present data accurately and effectively
For confidential consideration, please send resume via email to: email@example.com or apply online at www.health-partners.org.
CHP values a culture strengthened by diversity and inclusion. We welcome the ideas, experiences, perspectives and talents of a diverse workforce. EOE