Columbus, OH 43205-1381 US
Toledo, OH 43606 US
Wheeling, WV 26003-2941 US (Primary)
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. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.
The Health Management Solutions team is recruiting for a RN Case Manager to join their team. The RN Case Manager will communicate with injured workers [IW], employers, providers, third party administrators, attorneys and the Ohio Bureau of Worker’s Compensation [BWC] in order to obtain a safe RTW while meeting or exceeding Degree of Disability Management [DODM] benchmarks. They process C-9 Treatment Requests within 72 hours in order to provide the IW with the treatment medically necessary and appropriate for the allowed conditions. The RN Case manager will coordinate with the Catastrophic Nurse Case Manager to medically manage life care plans for catastrophic claims. They also follow up with providers to obtain current treatment plans, results of diagnostics and RTW goals.
The RN Case Manager is accountable for the case management process and supervises all members of the Team. They will review case loads of claims examiners and staffing individual claims when necessary. They monitor medical management of claims examiners, including initial assessment, development of treatment plans, identification of additional diagnosis, DODM, RTW for modified duties and/or RTW with full duty, case closures and follow-up.
•To adhere to all HMS policies, especially Confidentiality.
•To process C-9 Treatment Requests within 72 hours in order to provide the IW with the treatment medically necessary and appropriate for the allowed conditions.
•To staff C-9 Treatment Requests with the Medical Director as needed.
•To coordinate with the Catastrophic Nurse Case Manager to medically manage life care plans for catastrophic claims.
•To follow up with providers to obtain current treatment plans, results of diagnostics and RTW goals.
•To obtain modified duty availability from employers and restrictions from providers.
•To identify IWs who are potential vocational rehabilitation candidates and complete the referral process.
•To coordinate with the Vocational Rehabilitation Coordinator to medically manage care plans for vocational rehabilitation claims.
•To serve as a resource for staffing of difficult cases. To establish workflows and priorities for the team as needed. This includes delegating duties to claims examiners and administrative assistants on the team in order to meet expectations and guidelines.
•To be responsible for following BWC’s guidelines for appropriate medical management of claims.
•To participate in educational and informational seminars as needed.
•To accept other duties that may be assigned.
Health Management Solutions (HMS) is an Ohio Managed Care Organization (MCO) focused on reducing lost work time. Our safety and education programs help reduce work place injuries while hands-on workers' compensation case management and our extensive health provider network help injured workers return to work quickly and safely while working within BWC designated guidelines. Over 30,000 Ohio employers trust Health Management Solutions to medically manage their workers' compensation claims. With a dedicated claims management team and a strong focus on return to work, our employers can be confident that our staff will provide the employer and injured worker with high quality medical management.
- Case Managers must have an active, unrestricted RN license from an accredited college/university.
- An active license to practice nursing in the state of Ohio (verification is required before job position can be offered). The license must allow the Case Manager to conduct an assessment independently as permitted within the scope of their licensure based on the standards of the discipline.
HMS requires all nurse case managers to have at least one of the following:
- Certification as a case manager from the URAC-approved list of certifications; or
- A bachelors (or higher) degree in a health or human services related field; or
- A registered nurse (RN) license.
HMS requires that case managers obtain advanced certification in one of the following URAC recognized certifications approved within four years of date of hire (RNs employed prior to policy implementation on 01/01/12 have four years from that date to obtain advanced certification):
- CCM – Certified Case Manager
- CDMS – Certified Disability Management Specialist
- CMAC—Case Management Administrator, Certified
- CMC – Case Management Certified
- CRC – Certified Rehabilitation Counselor
- CRRN – Certified Registered Rehabilitation Nurse
- COHN—Certified Occupational Health Nurse
- COHN –S – Certified Occupational Health Nurse- Specialist
- RN-BC- Registered Nurse Case Manager
- ACM—Accredited Case Manager
- HMS requires all nurse case managers to have the equivalent of two (2) full-time years providing direct clinical care to consumers.
ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 56,000 employees, 13 hospitals, 2,100 physicians and advanced practice providers with privileges, 900 healthcare providers employed by ProMedica Physicians, a health plan, and nearly 400 assisted living facilities, skilled nursing and rehabilitation centers, memory care communities, outpatient rehabilitation clinics, and hospice and home health care agencies. Driven by its 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. For more information about ProMedica, please visit www.promedica.org/aboutus.
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.
Equal Opportunity Employer/Drug-Free Workplace