RN Care Manager

RN Care Manager - SummaCare
SummaCare E Market St, Akron, OH
Full-Time / 40 hours / Days

• Remote after training

As a regional, provider-owned health plan, SummaCare values the relationship between the members and their doctors. SummaCare is a part of Summa Health, an integrated healthcare delivery system that includes Summa Health System hospitals, its community-based health centers, dedicated clinicians and SummaCare.
Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.
Summary
Care Managers collaborate across a broad continuum of care to assess, plan, implement, coordinate, monitor and evaluate services to support and to meet individual member's health care needs; coordinates with physicians and other providers to provide optimal care for the member; determines the appropriate level of support from self-management education to end-of-life services; refers to community resources and clinical programs to improve quality of life for the member and to meet organizational goals related to quality outcomes, member experience, and cost-efficiency.

Formal Education Required

• Graduate of an accredited school of professional nursing or a school accepted for candidacy status from an accrediting body
• Current license to practice registered nursing in the State of Ohio

Experience & Training Required

• Three (3) years' experience to include previous industry, care coordination and/or homecare or community agency experience.
• Prior Care Management experience with a Health Insurance Company preferred.
• Certification Care Management (CCM) preferred

Other Skills, Competencies And Qualifications

• Typing of 30 Words per Minute with 96% accuracy rate.
• High: ability to communicate instructional and operational information verbally and in written form that may include correspondence, reports, instructional materials, system designs; ability to provide instruction and guidance required to supervise day-to-day departmental operations; ability to interface with internal staff, mid-upper management professionals, and general public.
• High: collecting, analyzing data from diverse sources; making recommendations and/or conclusions based on analyses; developing financial, data processing technical reports, procedures, systems that usually affect one department. Proofreading completed work to find and correct errors. Requires excellent attention to detail.
• Demonstrate knowledge and skills necessary to provide care appropriate to the age of the members serviced.
• Work cooperatively with team members to accomplish HSM mission and goals.
• Organize and manage time to accurately complete tasks within designated time frames in fast paced environment.
• Maintain current knowledge of and comply with regulatory and company policies & procedures.
• Maintain confidentiality of member health and business information.
• Flexible: ability to adjust work hours to meet business demands.
• Frequent overtime work throughout the year, with heavy overtime during peak periods. Occasional travel for most Care Managers which may require use of personal auto to visit a member or provider office, attend meetings, conferences, workshops, and/or seminars.
• Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity

Essential Functions

• Develops and maintains professional working relationships with PCPs, physician's office staff and clinicians, community resources, employers, and other health care providers.
• Carries out nursing process: Gathers pertinent information from a variety of sources including physician and hospital records, utilization data, plan records/data and information from other health care providers to assist in development of an individualized plan of care. Evaluates effectiveness of the plan of care, modifies and adjusts as appropriate to achieving desired process, utilization and clinical outcomes.
• Collaborates and integrates with PCP, members of the health care team, community caregivers, and member representatives/caregivers to develop member support systems and achieve recommended delivery of services for chronic and catastrophic/complex care coordination.
• Determines and provides/arranges for the appropriate level of support to meet the member needs, ranging from self-management education to complex care management to End of Life services; varying outreach frequency as member needs change.
• Evaluates member care scenarios against the member benefits to identify and implement alternative care options to improve quality of life, reduce the cost of care and insure efficient utilization of resources.
• Completes care management documentation according to NCQA, CMS and other regulatory standards and department procedures. Maintains up-to-date case management case status and labeling in the case management information system. Meets department standards and metrics for processing and managing cases.
• Participates in organizational and health system quality improvement and program activities as assigned by supervisor.
• Maintains working knowledge of NCQA and regulatory (CMS, State Department of Insurance) standards relative to care management; consistently delivers care management services in compliance with these standards.
• Performs all job functions with integrity. Provides timely internal and external customer service in cooperative, professional, and respectful manner.

Level Of Physical Demands

• Sit and/or stand for prolonged periods of time
• Bend, stoop, and stretch.
• Lift up to 20 pounds.
• Manual dexterity to operate computer, phone, and standard office machines.

Equal Opportunity Employer/Veterans/Disabled

$37.40/hr - $56.11/hr