Cincinnati, Case Management Team Lead, Cincinnati, OH
Paramount Case Management is currently recruiting for a Team Leader. The Case Management Team Lead will be a working team leader who serves as a clinical resource and is responsible for staff supervision and the day-to-day operations of case management. The team leader acts as an interdepartmental liaison to ensure prompt resolution of case management issues, questions, and concerns. The Case Management Team Lead will supervise Case Management Coordinators to ensure that all plan personnel policies are consistently administered through systematic quarterly feedback and annual performance appraisals along with documented counseling/disciplinary procedures, when necessary.
Some other responsibilities:
- Serve as departmental resource/educator/decision maker for case management processes using the Utilization/Case Management Program description, nursing education and experience.
- Ensure that regulatory and accreditation requirements for case management are met.
- Assist in development and update of policies and procedures for case management activities.
- Monitor potential high-dollar cases and collaborate with the Finance Department on case-specific expected risks.
- Prepare monthly report for Manager/Director, Utilization/Case Management outlining case management activities, including actual vs. expected performance, potential problem areas and opportunities for improvement.
- Maintain a reduced case management caseload as a working team leader.
- Must have ability to travel within the state of Ohio for provider and delegate relationship-building.
At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest.
- Current Ohio registered nurse’s license.
- Minimum 2-3 years recent clinical experience and 2 years utilization management experience with an HMO required; supervisory experience preferred.
- Knowledge of InterQual® or similar criteria, ICD-9/10, CPT and DRG coding.
- Excellent communication (oral and written) and organizational skills required. Ability to plan, coordinate and organize multiple priorities & exercise independent judgment.
- Demonstrated PC skills, including word processing/spreadsheet/database and graphics applications strongly preferred.
- Ability to move between company work stations and departments; ability to communicate on telephones and operate general office equipment, including computers.
- Valid driver’s license, reliable vehicle with proof of auto insurance.