Top 45 Utilization management nurse Jobs in Youngstown, Oh

Health Plan Care Manager (RN or LSW)
CommuniCare Advantage —Boardman, OH
- Full-time
- Nursing
- RN License
- Mid-level
Quick Apply
Registered Nurse (RN) New to Practice – Med Surg Oncology Unit 8WE – St. Elizabeth Youngstown Hospital
Mercy Health —Youngstown, OH
- Part-time
- Acute care
- Nursing
- RN License
- Health savings account
- Disability insurance
Registered Nurse (RN) – Med Surg. Ortho Neuro Unit 5WE – St. Elizabeth Youngstown Hospital
Mercy Health —Youngstown, OH
- Full-time
- Acute care
- Nursing
- RN License
- Health savings account
- Disability insurance
Registered Nurse (RN) — Med Surg Telemetry — St. Joseph Warren Hospital
Mercy Health —Warren, OH
- Acute care
- Nursing
- RN License
- Health savings account
- Disability insurance
Registered Nurse (RN) – Med Surg Ortho Trauma 5WE – St. Elizabeth Youngstown Hospital
Mercy Health —Youngstown, OH
- 12 hour shift
- Acute care
- Nursing
- Vital signs
- Health savings account
- Disability insurance
Registered Nurse (RN) - Intensive Care Unit (ICU) - St. Joseph Warren Hospital
Mercy Health —Warren, OH
- Nursing
- RN License
- PALS Certification
- Health savings account
- Disability insurance
Traveling Registered Nurse (RN) - Progressive Care (PCU) - System Flex
Mercy Health —Youngstown, OH
- Travel nursing
- Acute care
- Nursing
- Float pool
- Health savings account
- Disability insurance
12d
Registered Nurse (RN) – Med Surg Oncology 8WE – St. Elizabeth Youngstown Hospital
Mercy Health —Youngstown, OH
- Full-time
- Acute care
- Nursing
- RN License
- Health savings account
- Disability insurance
Registered Nurse (RN) – Med Surg Oncology 8WE – St. Elizabeth Youngstown Hospital
Mercy Health —Youngstown, OH
- Full-time
- Acute care
- Nursing
- RN License
- Health savings account
- Disability insurance
Registered Nurse (RN) – Med-Surg 3 – St. Joseph Warren Hospital
Mercy Health —Warren, OH
- Acute care
- Nursing
- RN License
- Health savings account
- Disability insurance
Registered Nurse (RN) – Med Surg 3 – St. Joseph Warren Hospital
Mercy Health —Warren, OH
- Acute care
- Nursing
- RN License
- Health savings account
- Disability insurance
Registered Nurse (RN) – Med Surg 3 – St. Joseph Warren Hospital
Mercy Health —Warren, OH
- Acute care
- Nursing
- RN License
- Health savings account
- Disability insurance
Registered Nurse (RN) – Med-Surg Telemetry – St. Joseph Warren Hospital
Mercy Health —Warren, OH
- Acute care
- Nursing
- RN License
- Health savings account
- Disability insurance
Registered Nurse (RN) – Neuro Intensive Care 5 SE – St. Elizabeth Youngstown Hospital
Mercy Health —Youngstown, OH
- Nursing
- RN License
- PALS Certification
- Health savings account
- Disability insurance
Registered Nurse (RN) — Med Surg — Oncology — St. Elizabeth Youngstown Hospital
Mercy Health —Youngstown, OH
- Full-time
- Acute care
- Nursing
- RN License
- Health savings account
- Disability insurance
Case Manager, RN or Social Worker PRN
Mercy Health Rehabilitation Hospital, Youngstown —Youngstown, OH
- Part-time
- Nursing
- RN License
- Hospital
- Tuition reimbursement
- 401(k) matching
Quick Apply
Registered Nurse
Optum —Hermitage, PA
- $28.27 - $50.48 an hour
- Full-time
- CPR Certification
- RN License
- Writing skills
Quick Apply
Primary Care/Concierge Nurse
Our Health Partners —New Wilmington, PA
- $24 - $32 an hour
- Full-time
- Nursing
- Vital signs
- RN License
- Health insurance
- Dental insurance
Quick Apply
8d
Registered Nurse (RN) — Weekend Only Program — St. Joseph Warren Hospital
Mercy Health —Warren, OH
- Nursing
- RN License
- Hospital
- Health savings account
- Disability insurance
13d
Registered Nurse (RN) - Observation Clinical Decision Unit 8S - St. Elizabeth Youngstown Hospital
Mercy Health —Youngstown, OH
- Full-time
- Acute care
- Nursing
- RN License
- Health savings account
- Disability insurance
2d

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Health Plan Care Manager (RN or LSW)

CommuniCare Advantage -
Boardman, OH

Quick Apply

Job Details

Full-time

Qualifications

Medicare
Chronic disease management
Professional ethics
Experience working with individuals with chronic illnesses
Working with geriatric patients
Medicaid health insurance
Driver's License
Medicare regulations
Utilization management
Computer skills
Medicaid
Healthcare software applications
Geriatrics
HEDIS

Full Job Description

Job Address:

7450 Keller Rd Cincinnati, OH 45243

CommuniCare Advantage is currently recruiting Health Plan Care Managers in Northeastern Ohio for our Medicare Advantage plan. Candidates must be licensed as a Registered Nurse or as a Social Worker in the state of employment.

PURPOSE/BELIEF STATEMENT:
The position of Care Manager is part of Healthcare Services and reports to the Director of Care Coordination who reports to the VP of Healthcare Services and Quality Operations. This position will have strong working relationships with the Chief Medical Officer and other key contributors across the enterprise. The Care Manager will be responsible for coordinating member-care, developing actionable care plans, communicating effectively, and ensuring high-quality healthcare services are delivered to members in an institutional setting within a special needs plan (ISNP).

JOB DUTIES & RESPONSIBILITIES

Care Coordination: Oversee and coordinate the care of assigned ISNP members, ensuring they receive timely and appropriate care as dictated by the SNP Model of Care. Average caseload of 75-100 ISNP members with the ability to cross cover other clinicians as deemed necessary.
Member Assessment: Perform initial, annual, transition of care (TOC) and change in condition health risk assessments (HRA) for ISNP care managed caseload. Assessments may include, but are not limited to additional assessments such as PHQ-9, MMSE, Medication Reconciliation, Advanced Directives, etc. The health risk assessment includes a systematic and pertinent collection of data about the health status of the member and requires the member/representative input. Accurate assessment determines cadence of visits/needs and frequency/intensity of care management oversight. Risk stratification is dictated by the specifics within the Model of Care and evaluated with each member interaction.
Care Planning: Formulate and implement a member centric holistic care plan that addresses identified needs by assessing the member/representative/family needs, issues, resources and care goals; determining and educating on the choices available to the individual member. Establish a care plan that is mutually agreed upon by the interdisciplinary care team and the member/representative/family. Care plans will be established and maintained utilizing the SMART framework (Specific, Measurable, Achievable, Relevant and Time-bound) and communicated to all members of the interdisciplinary care team.
Collaboration: Collaborate with the interdisciplinary team (ICT) which may include Medical Director, PCP, nurse practitioners/physician assistants, pharmacy, dietary, social workers, other clinical and non-clinical disciplines, facility staff, member representatives and family to establish, revise and continuously evaluate the member centric care plan and conduct documented interdisciplinary care team meetings to be able to work proactively rather than reactively. Care Manager will work closely with Utilization Management, Compliance and Quality to adhere to the Model of Care and ensure quality assurance, cost efficiency and member safety/satisfaction.
Member Education: Provide education to members and their families about managing chronic conditions and promotion of self-management strategies.
Documentation: Maintain accurate and timely documentation of member care activities and any interaction related to the member in compliance with healthcare regulations.

QUALIFICATIONS & EXPERIENCE REQUIREMENTS

Licensed master’s in social work or licensed Registered Nurse (RN) with a minimum of a bachelor’s degree
Clinicians must be clinically licensed in the State they are managing members or have compact licensure
Certified Case Management (CCM) certification or willing to obtain within 1 year of hire (company sponsored)
Active drivers license as this is NOT a remote role and must have reliable transportation to enable face to face visit to members in facilities
Minimum of 3-5 years in Case/Care Management preferred and/or 5+ years of direct patient care
Knowledge of value-based care, fee for service and Medicare Advantage/Dual (Medicare/Medicaid), NCQA, HEDIS and basic Utilization Management functions
Expertise in care coordination for geriatric and high-risk populations
Ability and experience utilizing a variety of applications and databases to fulfill care management requirements, and documentation. Documentation integrity is taken quite seriously and will be audited on a frequent basis.

KNOWLEDGE/SKILLS/ABILITIES

Critical thinking is key. Act before reacting
BE PRESENT both physically and for our members. Listen with compassion and learn to “walk in one’s shoes”
Must have integrity, be honest and have a strong ethical compass.
Nimble, establish boundaries and foster emotional intelligence
Strong planning and organizational and time management skills with the ability to work independently
Must be excited by the opportunity to work within an integrated delivery system
Strong communication skills and the ability to work effectively with people coming from diverse cultural and professional perspectives
Subject matter expert in care management
Excellent interpersonal, written, and organizational skills required

Quick Apply

Refine Your Search

utilization management nurse jobs in youngstown, oh

Health Plan Care Manager (RN or LSW)

Registered Nurse (RN) New to Practice – Med Surg Oncology Unit 8WE – St. Elizabeth Youngstown Hospital

Registered Nurse (RN) – Med Surg. Ortho Neuro Unit 5WE – St. Elizabeth Youngstown Hospital

Registered Nurse (RN) — Med Surg Telemetry — St. Joseph Warren Hospital

Registered Nurse (RN) – Med Surg Ortho Trauma 5WE – St. Elizabeth Youngstown Hospital

Registered Nurse (RN) - Intensive Care Unit (ICU) - St. Joseph Warren Hospital

Traveling Registered Nurse (RN) - Progressive Care (PCU) - System Flex

Registered Nurse (RN) – Med Surg Oncology 8WE – St. Elizabeth Youngstown Hospital

Registered Nurse (RN) – Med Surg Oncology 8WE – St. Elizabeth Youngstown Hospital

Registered Nurse (RN) – Med-Surg 3 – St. Joseph Warren Hospital

Registered Nurse (RN) – Med Surg 3 – St. Joseph Warren Hospital

Registered Nurse (RN) – Med Surg 3 – St. Joseph Warren Hospital

Registered Nurse (RN) – Med-Surg Telemetry – St. Joseph Warren Hospital

Registered Nurse (RN) – Neuro Intensive Care 5 SE – St. Elizabeth Youngstown Hospital

Registered Nurse (RN) — Med Surg — Oncology — St. Elizabeth Youngstown Hospital

Case Manager, RN or Social Worker PRN

Registered Nurse

Primary Care/Concierge Nurse

Registered Nurse (RN) — Weekend Only Program — St. Joseph Warren Hospital

Registered Nurse (RN) - Observation Clinical Decision Unit 8S - St. Elizabeth Youngstown Hospital

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