RN Registered Nurse Case Manager

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 Personal Care Guide – Registered Nurse (RN) / Nurse Navigator is the clinical center of our healthcare navigation services. They act as designated clinical subject matter experts within their assigned teams of Care Coordinators (we call them Pods) and collaborate with peers and stakeholders in Utilization Review, Patient Services, Client Services and more. These licensed, professional healthcare warriors provide direct case management services to our members who may be navigating catastrophic illnesses and injuries, acute and chronic medical conditions, and everything in between.    What you’ll do Provide benefit and health information to each member so they are able to make informed health decisions; Serve as a member and provider advocate by educating and guiding through the complicated healthcare system.   Effectively translate and communicate clinical messages to members with empathy and patience.  Assist members and clients with wellness activities, enhanced benefits, behavioral incentives.  Identify members for specific case management and/or chronic condition management activities by utilizing established screening criteria.   Coordinate integrated health management services for each patient and provide benefit and health information to patients, caregivers, providers and facilities so they can make informed health decisions.  Use Quantum Health's systems and technology to accurately document all interactions related to patient care.  Apply nursing processes to actively manage members and achieve integrated health services through coordinated service efforts.  Assure a 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.  Maintain a collaborative relationship among health care teams by communicating information, responding to requests, building rapport, participating in team problem-solving methods.   All other duties as assigned.   What you’ll bring 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 in a hospital setting required.  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.