Director, Case Management

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.

2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Join our dynamic team at Medical Mutual, where we are committed to providing exceptional health insurance services. We are looking for a highly skilled and experienced Health Insurance Director, Case Management to lead our team in Ohio.

The Director, Case Management leads a team of clinicians that deliver case management services to targeted commercial and Medicare member populations with a range of health status / severity and clinical needs.

They also manage staff resources to ensure effective member outreach and engagement as well as achieving defined clinical and financial outcomes.

Responsibilities

• Analyzes trends and identifies / implements departmental initiatives, from production, quality, financial and audit data.
• Optimizes processes and workflows to achieve successful quality outcomes.
• Leads the development and oversight of key performance indicators and monitors and tracks to independently identify utilization patterns and / or deviation from expected results.
• Oversees the development and implementation of processes and systems to improve the efficiency and effectiveness of case management services.
• Develops effective relationships with key health systems to improve communication, efficiency and effectiveness of case management process including leading clinical meetings to facilitate relationship building and identifying opportunities to advance access to Electronic Medical Records (EMRs) / Portals.
• Oversees the recruiting, performance, development and mentoring of staff.
• Ensures that team members are clinically competent and adequately trained in motivational interviewing and other engagement techniques.
• Provides leadership and support to managers and supervisors.
• Ensures monitoring and tracking tools are in place to adequately link and assess production and quality driven work products and outcomes to individual performers.
• Leads talent management activities to develop and cultivate future leaders.
• Serves as the subject matter expert liaison for case management services and / or leader on cross-functional teams.
• Initiates cross functional / departmental discussions and initiatives to remove barriers and improve communications and workflows.
• Develops formal policies, procedures and workflows that effectively guide work activity.
• Performs other duties as assigned.

Qualifications

Qualifications

Education and Experience :

• Bachelor of Science in Nursing required. Master's degree preferred.
• 8 years progressive experience in managed care case management in a health plan, 5 years of which are in a leadership capacity.
• Experience with Medicare / Medicaid / Self-Funded lines of business.

Professional Certification(s) :

• Registered Nurse with current, unrestricted license in state of residency.
• Ability to obtain Ohio RN or Multi-state RN Compact License within 60 days of date of hire.
• Ability to obtain additional RN licensure for multi-state member management.

Technical Skills and Knowledge :

• Comprehensive knowledge of health plans, NCQA accreditation standards and CMS regulations, HIPAA compliance and the ability to apply advanced concepts to Company operations.
• Strong knowledge of health insurance benefits, care delivery processes, continuum of acute through post- acute care, and network plan designs.
• Strong knowledge of clinical claim management including ICD 10, CPT and HCPCS codes
• Strong communication and presentation skills.
• Intermediate to advanced proficiency with Microsoft Office, including Outlook, Excel, PowerPoint, Word, and electronic medical records systems.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees.

That's why we offer an exceptional package that includes :

A Great Place to Work :

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available.

Enjoy the use of weights, cardio machines, locker rooms, classes and more.

• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation :

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work / life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You :

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual :

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors.

Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans.

We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.

Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community.

We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.