Case Manager, Complex

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Make It Happen At Hopkins!

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHP is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP has become a leader in provider-sponsored health plans and is poised for future growth.

About this position:

Work Schedule: Monday - Friday, the core business hours are 8:00 AM - 5:00 PM

What awaits you:

• Work-life balance - This is a remote role.
• Medical, Dental, and Vision Insurance.
• 403B Savings Plan w/employer contribution.
• Generous Paid Time Off
• Health and wellness programs and MORE!

Who you are:

The Case Manager anticipates and coordinates care/services/health education for targeted patient populations with chronic disease conditions or high-cost specialty care. She/he demonstrates knowledge of case and disease management, prognosis, and outcomes, and is responsible for ensuring that patient goals are achieved within a specified time period based upon individual needs, reasonable expectations, and well-documented outcomes.

• Current registered nurse licensure in the state of Maryland preferred.

What you’ll do:

• Identifies and acts upon impending changes in patient condition.
• Identifies and analyzes staff/patient/system issues that impact the plan of care.
• Initiates corrective action.
• Reviews/interprets patient population-specific financial reports.
• Maintains budgeted caseload
• Makes decisions regarding work processes based on established guidelines.
• Understands and uses principles of negotiation.
• Effectively uses resources within control.
• May assign work to support staff

What you’ll bring:

• Demonstrated clinical expertise in acute care nursing with clinical expertise in a specialty area preferred.
• Knowledge of health care and managed care delivery systems.
• Standards of medical practice.
• Insurance benefit structures and related legal/ medical issues.
• Utilization management and quality improvement processes.
• Community resources.
• Ability to work in a dynamic, team-oriented environment and demonstrate positive relationship building.
• Effective verbal/ written communication.
• Ability to affect change.
• Ability to perform critical analysis, plan and organize effectively.
• Ability to promote patient/family autonomy.
• Business acumen so that health benefits and patient/provider satisfaction are maximized while solidifying the program’s viability through cost effective intervention.

Education: Bachelor’s degree in nursing or related years of experience, or MSW in social work preferred.

Work Experience:

• Minimum five (5) years clinical practice.
• Minimum three (3) years clinical practice in a specific specialty.
• Additional case management/ disease management or managed care experience preferred.

Licensure:

• Current registered nurse licensure in the state of Maryland or LCSW-C.
• Certification in case management (CCM) preferred.

Who we are:

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.