Registered Nurse (RN) Case Manager MediGold remote
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Job Location:
Columbus, NE - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Employment Type:
Full timeShift:
Day ShiftDescription:
Please note position is 100% remote however colleagues who reside within a 50mile radius of Columbus Ohio is required to come onsite 1x per quarter for quarterly meeting.Why MediGold
MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. Were dedicated to providing excellent customer service cost-effective care and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology financial analysis audit provider relations and more.
Position Purpose:
The RN Case Manager MCHP is responsible for the coordination of the medical care provided to Plan members with Plan providers the members family and other resources as appropriate. Assists in the implementation of Case Management software along with the Plans UM and QM Program and the review of the Plans Medical Management Plan.
What we are looking for:
- Education: Associate Degree in Nursing. Bachelors Degree as appropriate.
- Licensure / Certification: RN with current unrestricted state licensure required nursing compact license is preferred. Ability to obtain licenses from other participating states
- Experience: Minimum of 5-7 years of clinical nursing experience with at least 2 years experience in utilization review discharge planning case management or disease management experience required. Nursing experience in an HMO insurance company setting preferred.
- Demonstrated ability to analyze summarize and concisely report medical utilization and medical chart audit results.
- Ability to compare approved criteria with clinical information to determine appropriateness of service and to document all related information according to department policies and procedures.
- Conducts claim review as required for appropriate claims processing.
- Ability to implement and successfully utilize Case Management software.
What you will do:
- Coordinates with case management resources to assure development and documentation of a treatment plan for members who meet the Plans guidelines for Case Management and communicates the plan to the members PCP and other members of the care team.
- Completes an initial assessment of the members health status including medical history medications symptoms degree of support from family & friends and current treatment prescribed by the members physician.
- Provide telephone follow up at the frequency agreed upon and teaching to promote goal attainment as well as providing educational materials appropriate for that members condition.
- Assist member to be an advocate for their healthcare and assist with formulating questions to ask the physician as well as how to respond to common symptoms they might experience.
- Coordinates with the utilization review case management discharge planning staff within network facilities.
- Creates and maintains a case management database of referrals and treatment plans for Members.
- Coordinates with Medical Director/Associate Medical Directors on case-specific issues.
- Coordinates with Claims Member Services Grievance Coordinator and other operational departments regarding case management issues.
- Conducts inpatient concurrent review.
- Documents and communicates to QM staff appropriately all identified quality concerns related to Members.
- All other duties as assigned.
Position Highlights and Benefits:
Mount Carmel Health System recognized by Forbes in 2025 as one of Americas Best State Employers.
Competitive compensation and benefits packages including medical dental and vision with coverage starting on day one.
Retirement savings account with employer match starting on day one.
Generous paid time off programs.
Employee recognition programs.
Tuition/professional development reimbursement starting on day one.
RN to BSN tuition 100% paid at Mount Carmels College of Nursing.
Relocation assistance (geographic and position restrictions apply).
Employee Referral Rewards program.
Mount Carmel offers DailyPay - if youre hired as an eligible colleague youll be able to see how much youve made every day and transfer your money any time before deserve to get paid every day!
Opportunity to join Diversity Equity and Inclusion Colleague Resource Groups.
Ministry/Facility Information:
Mount Carmel a member of Trinity Health has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals free-standing emergency centers outpatient facilities surgery centers urgent care centers primary care and specialty care physician offices community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohios largest undergraduate graduate and doctor of nursing programs. If youre seeking a rewarding career where your purpose passion and desire to make a difference come alive we invite you to consider joining our team. Here care is provided by all of us For All of You!
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race color sex age national origin religion sexual orientation gender identity status as a veteran and basis of disability or any other federal state or local protected class.
Our Commitment
Rooted in our Mission and Core Values we honor the dignity of every person and recognize the unique perspectives experiences and talents each colleague brings. By finding common ground and embracing our differences we grow stronger together and deliver more compassionate person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability veteran status or any other status protected by federal state or local law.
Required Experience:
Manager
Key Skills
- EMR Systems
- Hospital Experience
- Acute Care
- ICU Experience
- Hospice Care
- Workers' Compensation Law
- Home Care
- Nursing
- Catheterization
- Critical Care Experience
- Medication Administration
- Tube Feeding
About Company
Trinity Health is one of the largest not-for-profit, Catholic health care systems in the nation. It is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians caring for diverse communities across 25 states. Nationally recognized for care and experience, the Trinity ... View more
