ProMedica Hiring for RN Behavioral Health CM – Paramount – Remote Remote
ProMedica’s health plan, Paramount Insurance, offers health insurance products across six Midwest states. Paramount is an Ohio-based health insurance company, headquartered in Toledo. The organization has more than 800 employees dedicated to serving their health plan members.
Paramount offers Medicare Advantage and Marketplace Exchange health plans for individuals and families. Paramount maintains accreditation by the National Committee for Quality Assurance (NCQA) for their HMO and Medicare Advantage products.
In addition, Paramount has a full complement of insurance products for employers of any size, including medical, dental, vision and workers’ compensation, as well as vocational rehabilitation, life-care planning and wellness.
As a part of ProMedica, Paramount is driven by ProMedica’s mission to improve your health and well-being. ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. Paramount strives to provide an exceptional experience to every member. For more information about Paramount, please visit our website. http://www.paramounthealthcare.com.
POSITION SUMMARY
Assesses, plans, implements, coordinates, monitors and evaluates the ongoing care of a specific caseload through the Continuum of Care; collaborates with members of the health care team, members and their families to ensure effective, efficient and appropriate care during the entire episode of illness and for post-discharge services. Monitors utilization and evaluates outcomes.
ACCOUNTABILITIES
- Assessment (25%): Assess identified members to determine case management needs by trigger diagnoses, disease management needs, high dollar cost, complex medical conditions, emergency room utilization, readmissions or excessive length of stay. Conduct a comprehensive health care plan review that includes member contact and PCP contact. Assess the member’s functional status, decision-making ability, and psycho-social needs.
- Planning (10%): Plan a flexible care plan developed in conjunction with the member, PCP, health care team and other persons involved in the member’s care. The plan should address the member’s health care needs identified in the assessment process.
- Implementation and Coordination (20%): Coordinate current treatment plans with the PCP and maximize benefits through in-Plan provider utilization. Utilize cost benefit analysis. Ensure communication of goals with all health care team members.
- Monitoring and Evaluation (10%): Review the member’s progress and conduct periodic reassessment of the care plan based on changing member needs. Evaluate, initiate and coordinate case management members’ potential discharge planning and follow-up needs. Evaluate and manage resources and optimize reimbursement to ensure that members receive the most appropriate care in the most cost-effective setting.
- Communication (20%): Provide members and families with ongoing, current information and support to enhance satisfaction throughout the continuum of care. Facilitate communication among members of the health care team. Ensure privacy and confidentiality under current federal regulations. Adherence to ethical, legal and accreditation/regulatory standards.
- Documentation (10%): Documentation follows current procedures. Has good knowledge of Health Care coverage, exclusions and Medicaid guidelines for appropriate system documentation. Demonstrates good skills in the required paper and electronic systems.
- General (5%): Act as a member advocate, maintain and ensure member privacy and confidentiality, adhere to ethical, legal and accreditation/regulatory standards for all Case Management activities/interventions. While most case management interaction is telephonic through out the case management process as defined above, multidisciplinary face to face meetings with members and providers may be beneficial and necessary to effectively coordinate the member’s treatment plan of care. Must have the ability to travel and make face to face visits with members.
- Perform other duties as directed.
REQUIRED QUALIFICATIONS
Education: Associate in Nursing
Skills: Excellent communication (oral and written) and organizational skills required. Demonstrated ability to plan, coordinate and organize multiple priorities.
Years of Experience: Three years experience with Medicaid/Medicare Health Care
License: RN
Certification: NA
PREFERRED QUALIFICATIONS
Education: Bachelor of Science in Nursing
Skills: Excellent communication (oral and written) and organizational skills required. Demonstrated ability to plan, coordinate and organize multiple priorities. Demonstrated PC skills, including word processing/spreadsheet/data base and graphics applications strongly preferred. Experience with electronic health record documentation.
Years of Experience: Three years experience with Medicaid/Medicare
License: Five years experience with Medicaid/Medicare Health Care
Certification: Certification in Case Management (CCM)
WORKING CONDITIONS
Personal Protective Equipment: N/A
Physical Demands: Ability to move between company work stations and departments; ability to communicate on telephones and operate general office equipment, including computers.
ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact [email protected]
Equal Opportunity Employer/Drug-Free Workplace