Remote Rn Case Manager Jobs in Columbus, OH (NOW HIRING)

Who we are

Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®.

We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.

About the role

The Transplant Nurse (PCG) facilitates care coordination for a member with the potential for a transplant, including hematologic malignancies and end stage disease processes. The position requires a multidisciplinary, collaborative approach to manage the complexity, financial impact, frequent resource utilization and variable acuity across the transplant continuum. Management begins at referral and follows through pre-transplant care, evaluation, the transplant phase to post-transplant case closure.

Location: This position is located at our Dublin, OH campus; Columbus candidates will be hybrid; candidates >50 miles from Columbus will have the option for remote work.

What you’ll do (Essential Responsibilities)

Identify and assess members with the potential for solid organ or bone marrow transplant, end stage renal disease and hematologic malignancies.   

Apply the nursing process when actively case managing transplant members.

Utilize well-developed critical thinking and interpersonal skills to problem-solve and make knowledgeable recommendations for needed actions.

Document all activities specific to members, caregivers, providers, facilities and clients in appropriate database. 

Maintain a collaborative relationship with members’ health care teams by communicating information, responding to requests, building rapport, participating in team problem-solving methods.

Serve as member and provider advocate by educating and guiding through the transplant process. 

Provide benefit and health information to each member so they are able to make informed health decisions. Promote the mission and core values of Quantum Health.

Maintain a working knowledge of all policies and procedures related to Clinical Operations.

Work closely with and provide updates to internal client executives and employer contacts for transplant patients.  

Maintain a working knowledge of employer health benefit plans and know where to access benefit information.

Be a clinical resource for all Quantum Health work teams.

Maintain working knowledge of Transplant Vendor contracts, single case rate agreements, access agreements, and negotiated agreements as required by client plan design. 

Assist members and clients with wellness activities, enhanced benefits, behavioral incentives

Be a transplant clinical resource for all Quantum Health work groups.

Work closely with and provide updates to internal client executives and employer contacts for transplant patients.

Maintain contact with the QH clinical staff for transfer of cases when appropriate

All other duties as assigned.

What you’ll bring (Qualifications)

Licensure and Credentialing: Must hold an active, unrestricted, and unencumbered professional license in good standing with the state board of licensure as a Registered Nurse (RN). Where applicable, clinicians must hold a Multi-State License (MSL) issued through the relevant licensure compact (e.g., Nurse Licensure Compact for RNs). For clinicians in states that do not offer MSL, or for disciplines for which an MSL program has not been launched, employees must be willing and able to obtain and maintain additional state licenses as required to support members served by the organization. Both the MSL and individual state licenses must be obtained within 90 days of hire. Maintenance of required licensure, including timely renewal and compliance with state board regulations, is a condition of employment. 

The Certified Case Manager (CCM) credential from the Commission for Case Manager Certification is strongly preferred upon hire for clinicians performing case management functions. Employees hired without the certification are required to obtain the CCM within 24 months of hire or role placement. Once obtained, the employee must maintain the CCM credential in good standing and complete all continuing education and renewal requirements established by the certifying body. Failure to maintain required certification may result in removal from case management duties or other corrective action.

Education: Bachelor’s of Nursing preferred

Experience: Minimum of two years clinical experience with direct patient care required

Outstanding computer skills including Microsoft applications

Excellent critical thinking skills

Possess excellent verbal and written communication skills

Possess excellent time management skills

Demonstrate ability to work autonomously

Solid organ or bone marrow transplant experience desired

Protect and take care of our company and member’s data every day by committing to work within our company ethics and policies.

#LI-HW1 #LI-Remote