Care Manager - Enhanced Case Management at The Ohio State University in OSU Health Plan

Job description

Screen reader users may encounter difficulty with this site. For assistance with applying, please contact hr-accessibleapplication@osu.edu . If you have questions while submitting an application, please review these frequently asked questions . Current Employees and Students: If you are currently employed or enrolled as a student at The Ohio State University, please l og in to Workday to use the internal application process. Welcome to The Ohio State University's career site. We invite you to apply to positions of interest. In order to ensure your application is complete, you must complete the following: Ensure you have all necessary documents available when starting the application process. You can review the additional job description section on postings for documents that may be required. Prior to submitting your application, please review and update (if necessary) the information in your candidate profile as it will transfer to your application. Job Title: Care Manager - Enhanced Case Management Department: Scope of Department The Clinical Operations Department is responsible for all OSU Health Plan medical and pharmacy benefits and the development, execution, and evaluation of clinical programs that provide quality and cost-effective care to health plan members. Scope of Position This position serves as a Care Manager for health plan nursing care management programs and reports to the CM Manager. The Care Manager is responsible for delivering superior customer service and achieving clinical and operational excellence as it relates to the implementation and execution of OSU Health Plan medical/pharmacy benefits and clinical programs (i.e., Care Coordination, Enhanced Case Management, Buckeye Baby). The position is tasked with ensuring highly personalized, innovative, and cost-effective services for all OSU Health Plan members. The Care Manager is responsible for resolving escalated member/provider concerns and working with the CM Manager and team clinicians to provide quality assurance for our top-quality clinical programs. The Care Manager may manage members across the lifespan, including pediatric patients with complex acute/chronic conditions and complex medical/developmental/psychosocial needs, and collaborates with family members, caregivers, community agencies, and specialty providers as appropriate. The Care Manager provides informal guidance to other care management program staff including new PCRMs. Position Summary: The Care Manager serves as a member of the service team responsible for executing and promoting care management programs for university health plan members and affiliated groups by collaborating with the members and their health care team. The Care Manager reports to the CM Manager and works collaboratively with directors, managers, and clinicians to ensure delivery of differentiated affordable, high-quality, and personalized health care services in an accessible, patient-friendly, focused atmosphere. The Care Manager guides and supports new CM team members. The Care Manager utilizes expanded conceptual and practical disease state knowledge to manage a caseload of moderate to high-risk adult and pediatric patients with acute/chronic conditions and complex medical/psychosocial needs; exercises clinical process, critical thinking, and problem-solving skills to collaborate with members, providers, practice managers, and internal clinicians to solve benefit issues in an accurate and timely manner and ensure members receive high-level care throughout the care continuum ; collaborates to facilitate safe and timely discharge planning in the acute and post-acute setting, including but not limited to the following settings: acute inpatient hospitalization, LTACH, skilled nursing facility, home health care, hospice; identifies opportunities and resources to address health care needs; performs clinical review and utilization management activities as necessary; documents clinical review findings and authorization