Supervisor, Case Management

Job Summary

Organizes and manages the workflow of all activities and the day-to-day operations in case management. Performs supervisory functions including selection, coaching, and performance appraisal of case management staff. Participates in process improvement and quality team initiatives.

Responsibilities

• Oversees the operations of care management staff in their day to day functions within a department.
• Works to ensure that staff maintain clinical competencies that enable them to effectively achieve case management outcomes.
• Monitors and evaluates the effectiveness of programs and procedures and recommends and/or implements changes as indicated.
• Reviews production and quality data to ensure accuracy and consistent application of policies and procedures.
• Participates in recruitment, selection, hiring, orientation, counseling and evaluation of staff.
• Serves as a resource for other departments and external customers in resolving complex issues related to department functions.
• Performs other duties as assigned.

Qualifications

Education and Experience:

• Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor's Degree preferred.
• 7 years progressive experience as a Case Manager in health insurance or equivalent experience as an RN in clinical practice, utilization review, or case management.
• Relevant experience leading teams or projects (formally or informally).

Professional Certification(s):

• Registered Nurse with current State of Ohio unrestricted license.
• Certified Case Manager (CCM) or other industry recognized certification preferred (if not certified, required to obtain within 3 years of hire.)

Technical Skills and Knowledge:

• Intermediate Microsoft Office skills and proficiency navigating windows and web-based systems.
• Knowledge of medical terminology/coding and managed care processes.
• Knowledge of and the ability to apply fundamental concepts related to HIPAA compliance and related regulations.
• Knowledge of disease continuums, expected patient outcomes and community services available.
• Strong knowledge of clinical claim management including ICD 10, CPT and HCPCS code.
• Strong knowledge of health insurance benefits and network plan designs.
• Knowledge of care delivery systems and continuum of acute through post-acute care
• Ability to manage workload and coach staff.

A Great Place to Work

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

Equal Opportunity Employer

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.