Who we are
Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®.
We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.
About the role
The Registered Nurse (RN) Case Manager is a key member of a cross-functional care team, driven by their mutual devotion to serve others. Members view Case Managers as their patient care guides, advocating for them during some of the most challenging times of their life—facing catastrophic illness, injury or acute and chronic medical conditions. The Case Manager’s clinical expertise and integrated health approach provides each unique patient with education and guidance as they navigate the complexities of health care.
Location: This position is located at our Dublin, OH campus with hybrid flexibility. Rotating work from home days. No weekends or holidays
What you’ll do (Essential Responsibilities)
Identify members for specific case management and/or chronic condition management activities using established screening criteria.
Apply nursing processes to actively manage members and achieve integrated health services through coordinated service efforts.
Provide education and guidance to members and providers to successfully navigate healthcare complexities.
Maintain high quality of care by adhering to therapeutic standards, measuring health outcomes against member care goals and standards, making/recommending necessary care adjustments, and following hospital and nursing division’s philosophies and standards of care set by state board of nursing, state nurse practice act and other governing agency regulations.
Document all activities specific to members, caregivers, providers, facilities and clients in appropriate databases.
Maintain collaborative relationships amongst health care teams through effective communication, responsiveness, building rapport and collaborative problem solving.
Assist members and clients with wellness activities, enhanced benefits and behavioral incentives.
All other duties as assigned.
What you’ll bring (Qualifications)
Licensure and Credentialing: Must hold an active, unrestricted, and unencumbered professional license in good standing with the state board of licensure in one of the applicable clinical disciplines: Registered Nurse (RN). Where applicable, clinicians must hold a Multi-State License (MSL) issued through the relevant licensure compact (e.g., Nurse Licensure Compact for RNs). For clinicians in states that do not offer MSL, or for disciplines for which an MSL program has not been launched, employees must be willing and able to obtain and maintain additional state licenses as required to support members served by the organization. Both the MSL and individual state licenses must be obtained within 90 days of hire. Maintenance of required licensure, including timely renewal and compliance with state board regulations, is a condition of employment.
The Certified Case Manager (CCM) credential from the Commission for Case Manager Certification is strongly preferred upon hire for clinicians performing case management functions. Employees hired without the certification are required to obtain the CCM within 24 months of hire or role placement. Once obtained, the employee must maintain the CCM credential in good standing and complete all continuing education and renewal requirements established by the certifying body. Failure to maintain required certification may result in removal from case management duties or other corrective action.
Education: Bachelor of Science in Nursing (BSN) preferred.
Experience: 2+ years of clinical experience with direct patient care required; 5+ years preferred.
Experience in case management/coordination of programs and services preferred.
Excellent verbal and written communication skills. Comfortable communicating with members and providers via phone regularly throughout the day.
Ability to communicate effectively with members and providers in implementing clinical services; Translate complex clinical concepts for non-clinical audiences.
Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.
Trustworthy and accountable behavior, capable of viewing and maintaining confidential information daily.
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