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Position Summary

My Care of Ohio hiring for care management in one of our c ounties we serve, Franklin, Delaware, Madison, Pickaway or Union county.

• Nurse Case Manager/Clinical Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.
• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration.
• Services strategies policies and programs are comprised of network management and clinical coverage policies.
• Our Care Managers are frontline advocates for members who cannot advocate for themselves.
• T hey are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.
• Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
• Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Assessments include the member's level of work capacity and related restrictions/limitations.
• Using a holistic approach assess the need for a referral to clinical resources for assistance in g functionality.
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

• Must have active and unrestricted RN licensure in the state of Ohio
• 3+ years of clinical experience as RN
• 3+ years of experience as an LISW
• Must be willing and able to travel up to 50% -75% in Franklin, Delaware, Madison, Pickaway or Union counties. Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy
• 1+ year of experience with the Microsoft Office suite

• Home Health experience
• Computer Skills (Microsoft office such as: Word, Excel, and outlook)
• Bilingual preferred

• Associate's degree or Nursing Diploma Required
• Bachelor's degree Preferred for RN
• Masters in social work with independent license Required for LISW