Insurance Nurse Case Manager Jobs in Columbus, OH

Battelle delivers when others can't. We conduct research and development, manage national laboratories, design and manufacture products and deliver critical services for our clients-whether they are a multi-national corporation, a small start-up or a government agency.
We recognize and appreciate the value and contributions of individuals from a wide range of backgrounds and experiences and welcome all qualified individuals to apply.
Job Summary
The Health Research and Analytics (HRA) business line is seeking a highly motivated, full-time Nurse Case Manager to join our team in support of our government customer, U.S. Special Operations Command. This position will play a critical role in advancing the Preservation of the Forces and Family (POTFF) program, which is dedicated to optimizing and sustaining the mission readiness, longevity, and performance of Special Operations Forces (SOF). Through integrated and holistic human performance initiatives, POTFF strengthens both the Forces and their families, ensuring comprehensive support for those who serve. As a Nurse Case Manager, you will contribute to impactful research and analytics that drive evidence-based decision-making and enhance the effectiveness of these vital programs. This is an exciting opportunity to make a meaningful difference in the lives of SOF personnel and their families while working in a dynamic, mission-driven environment.
This position applies professional health nursing principles and clinical expertise to analyze and address complex patient needs, ensuring appropriate and cost-effective treatment. This role involves collecting and communicating detailed health data, developing time-sensitive treatment plans, assessing patient care via telephone, and coordinating discharge planning to optimize care delivery and outcomes. Additionally, the Nurse Case Manager facilitates referrals, collaborates with healthcare providers, and manages service agreements to support efficient, effective, and compliant patient care.
Responsibilities

• Provide a full range of professional health nursing principles, practices, and procedures in clinical settings to analyze the full scope of problems associated with providing appropriate, cost-effective care to Department of Defense (DOD) beneficiaries
• Collect, organize, record, and communicate data relevant to primary health assessments including a detailed medical history to develop time sensitive treatment plans which delineate the expected process of care delivery for selected case managed patients or populations
• Assess patient care via the telephone, using established protocols to provide appropriate and cost-effective care
• Establish priorities for patient care monitors and evaluate progress toward the stated goals to provide coordinated, efficient, effective health care to its beneficiaries
• Oversee discharge-planning activities to ensure ideal timing and sequencing of patient care
• Provides professional assistance to health care finders to identify patient's needs for referrals to appropriate health care providers or facilities
• Negotiate, write, finalize, and administer product/service agreements to ensure mutual compliance in meeting care goals

Key Qualifications

• Certified as a case manager by a recognized certifying organization, i.e., Commission for Case Management Certification or American Nurse Credentialing Center
• At least two years' nursing experience
• Current, full, active, and unrestricted license as a Registered Nurse in any U.S. State, the District of Columbia, Guam, Puerto Rico or U.S. Virgin Islands
• Ability to seek feedback from peers, professional colleagues, clients, and outcomes research, to expand clinical knowledge, enhance role performance, and increase knowledge of professional issues.
• Experience effectively consulting with health care providers at all levels and negotiating with outside providers for services and products to obtain client services and support
• Experience understanding diagnoses to assist patients to optimize their level of function and self-care
• Possess knowledge of patient education principles and management of complex medical, psychosocial, and financial problems to enhance patient adherence to individualized treatment plans and train peers and staff
• Maintain credentialing requirements in good standing at a local MTF
• Possess oral and written communication skills to meaningfully interact with peers, outside agencies, vendors, providers, and Military Health System (MHS) stakeholders to exchange information, provide briefings, presentations, research, and metrics to demonstrate or advance effective, efficient case management practice, outcomes, and organizational/MHS value.
• Experience in team coordination, facilitation, and communication to facilitate the exchange of information/education, enhance goal achievement, augment abilities of client support network, and effect change in system or policy at any level
• Knowledge of local, state, and federal laws and regulations, professional code of ethics, and practice standards to ensure adherence within legal and professional parameters
• Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance
• Knowledge and skills in the use of VA/DOD Clinical Practice Guidelines to ensure an evidence-based standardized process of care to military beneficiaries
• Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources
• Experience using research tools to critically evaluate existing practices, opportunities, and outcomes
• Experience in management of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to involved stakeholders
• Knowledge of computers and software applications to conduct data collection, tracking, rending, and analysis
• Ability to design and present computer-generated outcome analysis information to provide timely, effective peer and higher-level educational programs or project briefings
• Knowledge of pharmaceuticals, their desired effects, side effects, and complications of their use to gauge their effect on patients and their recovery
• Knowledge of community resources, patient entitlement/benefit eligibility, and ability to access these resources to assist patients/families in optimizing their level of function and self-care
• Knowledge of current third-party regulations and policies, with special emphasis on TRICARE and Medicare benefits and services, to identify alternative financing sources to which DOD beneficiaries may be entitled

Additional Qualifications

• May be required to receive and maintain clinical practice privileges
• Current certification in Basic Cardiac Life Support (BCLS) from the American Heart Association, with documentation provided
• Ability to obtain and maintain a U.S. government security clearance

Benefits: Live an Extraordinary Life
We care about your well-being, not just on the job. Battelle offers comprehensive and competitive benefits to help you live your best life.

• Balance life through a compressed work schedule: Most of our team follows a flexible, compressed work schedule that allows for every other Friday off-giving you a dedicated day to accomplish things in your personal life without using vacation time.
• Enjoy enhanced work flexibility, including a hybrid arrangement: You have options for where and when you work. Our Together with Flexibility model allows you to work 60% in-office and 40% remote, with Monday and Tuesday as common in-office days, dependent on team and position needs.
• Take time to recharge: You get paid time off to support work-life balance and keep motivated.
• Prioritize wellness: Stay healthy with medical, dental, and vision coverage with wellness incentives and benefits plus a variety of optional supplemental benefits.
• Better together: Coverage for partners, gender-affirming care and health support, and family formation support.
• Build your financial future: Build financial stability with an industry-leading 401(k) retirement savings plan. For most employees, we put in 5 percent whether you contribute or not, and match your contributions on top of that.
• Advance your education: Tuition assistance is available to pursue higher education.

A Work Environment Where You Succeed
For brilliant minds in science, technology, engineering and business operations, Battelle is the place to do the greatest good by solving humanity's most pressing challenges and creating a safer, healthier and more secure world.
You will have the opportunity to thrive in a culture that inspires you to:

• Apply your talent to challenging and meaningful projects
• Receive select funding to pursue ideas in scientific and technological discovery
• Partner with world-class experts in a collaborative environment
• Nurture and develop the next generation of scientific leaders
• Give back to and improve our communities

Vaccinations & Safety Protocols
Battelle may require employees, based on job duties, work location, and/or its clients' requirements to follow certain safety protocols and to be vaccinated against a variety of viruses, bacteria, and diseases as a condition of employment and continued employment and to provide documentation that they are fully vaccinated. If applicable, Battelle will provide reasonable accommodations based on a qualified disability or medical condition through the Americans with Disabilities Act or the Rehabilitation Act or for a sincerely held religious belief under Title VII of the Civil Rights Act of 1964 (and related state laws).
Battelle is an equal opportunity employer. We provide employment and opportunities for advancement, compensation, training, and growth according to individual merit, without regard to race, color, religion, sex (including pregnancy), national origin, sexual orientation, gender identity or expression, marital status, age, genetic information, disability, veteran-status veteran or military status, or any other characteristic protected under applicable Federal, state, or local law. Our goal is for each staff member to have the opportunity to grow to the limits of their abilities and to achieve personal and organizational objectives. We will support positive programs for equal treatment of all staff and full utilization of all qualified employees at all levels within Battelle.
The above statements are intended to describe the nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, activities and skills required of staff members. No statement herein is intended to imply any authorities to commit Battelle unless special written permission is granted by Battelle's Legal Department.
For more information about our other openings, please visit www.battelle.org/careers