Case Manager II

Position Overview

The Case Manager II position allows you the flexibility to work at home as long as you reside within a 50-mile radius of the Toledo, OH Medical Mutual office.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us and help our members achieve their best possible health and quality of life.

Under limited supervision, evaluates and provides support to members, their families, and physicians in addressing member needs. Educates members and families to make informed personal health care decisions and determines the most effective treatment options. Facilitates communication between member, physician, and community.

Responsibilities

• Independently manages complex health care cases by multiple means such as phone, email, and video conferencing. Verifies eligibility, benefits, enrollment history, clinical history, and demographics. Assesses patient needs by gathering information from the member, family, provider, and other stakeholders to monitor and evaluate for medical appropriateness and quality of care. Educates members and assists them in removing barriers and with various treatment options.

• Facilitates and implements interventions based on the agreed upon care treatment plan developed in collaboration with all participants in the member's healthcare team. Coordinates services with community resources and support groups with members.

• Keeps up to date on and maintains appropriate documentation within Company and regulatory guidelines, policies, and practices.

• If assigned to Preceptor/Trainer task: Orients, trains, and provides guidance to more junior or less experienced staff. Supports implementation of new procedures, processes, or clinical systems.

• 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.

• 3 years as a Registered Nurse with a combination of clinical and case management experience, preferably in the health insurance industry.

• Home health care experience is a plus.

Professional Certification(s):

• Registered Nurse with current State of Ohio unrestricted license. Multiple state licensure preferred and may be required.

• Certified Case Manager (CCM) or other industry recognized certification preferred (required within 3 years of hire).

• Certification in Motivational Interviewing preferred.

Technical Skills and Knowledge:

• In-depth knowledge of health insurance benefits, health plans, and industry trends, and the ability to apply knowledge to achieve positive outcomes.

• Strong knowledge of behavioral change techniques and health coaching (ex. readiness to change and motivational interviewing).

• 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.

• Intermediate proficiency navigating windows and web-based systems and basic Microsoft Office skills.

Benefits

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

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.