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RN, Case Manager - ProMedica Medical Management - Full Time - Days

Location
Valley Grove, West Virginia
Posted
11 Sep 2022
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

SuccessProfile

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
Compassionate 9
Communicator 9
Adaptable 9
Multi-tasker 8

Additional success profiles:
Detail oriented, Flexible, Helpful, Patient, Responsible, Sincere, Understanding

Benefits

Professional Growth
Retirement & Savings Plan
Innovative Training Programs
Tuition AssistanceCareer Stability
Comprehensive Health Coverage

Job Requirements

ProMedica's health plan, Paramount Insurance, offers health insurance products across six Midwest states. Paramount is an Ohio-based health insurance company, headquartered in Toledo. The organization has more than 800 employees dedicated to serving their health plan members.



Paramount offers Medicare Advantage and Marketplace Exchange health plans for individuals and families. Paramount maintains accreditation by the National Committee for Quality Assurance (NCQA) for their HMO and Medicare Advantage products.



In addition, Paramount has 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, Paramount is driven by ProMedica's mission to improve your health and well-being. ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. Paramount strives to provide an exceptional experience to every member. For more information about Paramount, please visit our website.  .



 



The ProMedica Medical Management team is recruiting for a RN Case Manager to join their team. The RN Case Manager will communicate with injured workers [IW], employers, providers, third party administrators, attorneys and the Ohio Bureau of Worker's Compensation [BWC] in order to obtain a safe RTW while meeting or exceeding Degree of Disability Management [DODM] benchmarks. They process C-9 Treatment Requests within 72 hours in order to provide the IW with the treatment medically necessary and appropriate for the allowed conditions. The RN Case manager will coordinate with the Catastrophic Nurse Case Manager to medically manage life care plans for catastrophic claims. They also follow up with providers to obtain current treatment plans, results of diagnostics and RTW goals.



The RN Case Manager is accountable for the case management process and supervises all members of the Team. They will review case loads of claims examiners and staffing individual claims when necessary. They monitor medical management of claims examiners, including initial assessment, development of treatment plans, identification of additional diagnosis, DODM, RTW for modified duties and/or  RTW with full duty, case closures and follow-up. 



ProMedica Medical Management is an Ohio Managed Care Organization (MCO) focused on reducing lost work time. Our safety and education programs help reduce work place injuries while hands-on workers' compensation case management and our extensive health provider network help injured workers return to work quickly and safely while working within BWC designated guidelines.  Over 30,000 Ohio employers trust ProMedica Medical Management to medically manage their workers' compensation claims. With a dedicated claims management team and a strong focus on return to work, our employers can be confident that our staff will provide the employer and injured worker with high quality medical management.


Education:



  • Case Managers must have an active, unrestricted RN license from an accredited college/university.

Professional Qualifications:



  • An active license to practice nursing in the state of Ohio (verification is required before job position can be offered). The license must allow the Case Manager to conduct an assessment independently as permitted within the scope of their licensure based on the standards of the discipline. 

 



HMS requires that case managers obtain advanced certification in one of the following URAC recognized certifications approved within four years of date of hire (RNs employed prior to policy implementation on 01/01/12 have four years from that date to obtain advanced certification):



  • CCM - Certified Case Manager

  • CDMS - Certified Disability Management Specialist

  • CIRS - Certified Insurance Rehabilitation Specialist

  • CRC - Certified Rehabilitation Counselor

  • RNCM- Nurse Case Manager

  • CRRN - Certified Registered Rehabilitation Nurse

  • GCM - Geriatric Care Manager

  • COHN - Certified Occupational Health Nurse

  • ACCC - Advanced Competency Certification in Continuity of Care

 



Experience:



  • PMM requires all nurse case managers to have the equivalent of two (2) full-time years providing direct clinical care to consumers.

 



ProMedica is a mission-based, not-for-profit health and well-being organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 49,000 employees, 13 hospitals, 2,500+ physicians and advanced practice providers with privileges, 1,000+ healthcare providers employed by ProMedica Physicians, a health plan, and 330+ assisted living facilities, skilled nursing and rehabilitation centers, memory care communities, and hospice and home health care agencies. Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. For more information about ProMedica, please visit  .



Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.



Equal Opportunity Employer/Drug-Free Workplace

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Details

  • Job Reference: 709520306-2
  • Date Posted: 11 September 2022
  • Recruiter: ProMedica
  • Location: Valley Grove, West Virginia
  • Salary: On Application